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www.ncbon.com
FALL 2013 VOLUME 10 {NO 1} EDITION 28
Bulletin Nursing
{Official Publication of the North Carolina Board of Nursing}
www.ncbon.com
Social Networking
and Nurses
Page 10
2 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
FALL 2013 BULLETIN
NC BOARD OF NURSING
Nursing Bulletin is the official
publication of the North
Carolina Board of Nursing.
Office Location
4516 Lake Boone Trail
Raleigh, NC 27607
Mailing Address
P.O. Box 2129
Raleigh, NC 27602
Telephone
(919) 782-3211
Fax
(919) 781-9461
Automated Verification
(919) 881-2272
Website
www.ncbon.com
Office Hours
8 a.m. to 5 p.m.,
Monday through Friday
Board Chair
Dr. Peggy C. Walters, RN
Executive Director
Julia L. George, RN, MSN, FRE
Editor
David Kalbacker
Photography
DayMeetsNight Media Services
Mission Statement
The mission of the North
Carolina Board of Nursing is to
protect the public by regulating the
practice of nursing.
Advertisements contained herein
are not necessarily endorsed by the
North Carolina Board of Nursing.
The publisher reserves the right to
accept or reject advertisements for
the Nursing Bulletin.
All art (photos, paintings, draw-ings,
etc.) contained in this pub-lication
is used under contractual
agreement.
145,000 copies of this document
were printed and mailed for a cost of
$0.12 per copy.
The North Carolina Board of
Nursing is an equal opportunity
employer.
VOLUME 10 { NO 1} EDITION 28
Table of Contents
8 Election Results for 2013
NC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Social Networking and Nurses
Chastain recipient of Employee
Excellence Award
22
Attention: Are You Interested in an
Out-of-State Nursing Program?
18
14 CE Opportunities for 2013
Calling All RNs, LPNs, Nursing
Managers, and Nursing Faculty!
Opportunities Available for YOU!
8
Bulletin Nursing
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DEPARTMENTS:
4 From the Executive Director
6 From the Board Chair
19 Summary of Actions
30 Classifieds
24 Prescription data reported to CSRS
15 Decision Tree for Delegation for UAP
28 The Art of Nursing & the Computer.”
4 Bulletin { Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . .
Nursing
Official Publication Nursing from the
Executive Director
Up to Full
strength and
moving forward
NC
As we move into the last quarter of 2013 I am
happy to report several recent accomplishments
here at the Board.
The Board is once again back to its
full compliment of 14 members with the
appointment of Pat Campbell, RN. Her
appointment came at the end of the legislative
session. She was appointed by the Speaker-of-
the House of the General Assembly. Also,
relating to Board members, congratulations to
Robert Newsom, LPN on his re-election to the
Board for a second term. Congratulations as
well to Deborah Herring, RN who was elected
from among a field of 10 candidates for the RN-At-
Large seat on the Board. Ms. Herring, who
will join the Board in January, is the Director of
Nursing at the Pitt County Health Department,
in Greenville.
Board members and staff have worked
diligently on the development the Board’s
proposed Strategic Plan for 2014-2017. In the
coming weeks this plan will be posted to the
Board’s website.
And speaking of websites …. We hope you
like our updated version. Additional updates
and changes are still being made but our overall
goal was to make it easier for licensees and the
general public to find the information they need.
A new on-line licensure system has also
recently been launched that provides enhanced
security and functionality to all licensees.
A recent review of the number of North
Carolina nurses taking advantage of our featured
CE stories is very encouraging. Thousands of
nurses have read these important articles and
this issue of the Bulletin contains a CE article on
utilizing social networking. Author and Board
staff member Crystal Tillman Harris, RN, DNP
gives readers several compelling do’s and don’ts
( P. 10)
Last, but truly not least, there are some
recent staff accomplishments noted in this
issue. They include: Kathy Chastain’s, RN,MN,
FRE receipt of the 2013 NCBON Employee
Excellence Award (P. 22) and Kathleen
Privette’s, RN,MSN,FRE completion of the
Institute of Regulatory Excellence Fellowship
progam ( P. 22)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
As a licensed nurse in North Carolina, you have
the opportunity to elect nursing members each
year who are charged by the General Assembly
to ensure minimum standards of competency and
provide the public safe care. In addition, the Board
has the responsibility to review its own composition,
leadership and terms of office to ensure Board
positions and member qualifications align with the
health care environment in order to make informed
decisions regarding regulation.
In September 2012, the Board appointed an Ad
Hoc Committee charged with gathering meaningful
data to make an informed decision regarding Board
composition, leadership and terms. Please take a
few moments to complete the Board Composition
and Tenure survey located on the home page of the
Board’s website (www.ncbon.com).
If you would like more information regarding the
functions and responsibilities of the Board prior to
completion of the survey, you can visit our website
at http://www.ncbon.com/dcp/i/board-information-historical-
information.
Thank you in advance for providing your valuable
feedback!
Your Board!
Your Voice!
NC
6 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The North Carolina Board of Nursing began
2013 celebrating 110 years of excellence in nursing
regulation. We are still celebrating! In 1902 the
visionary work of Mary Lewis Wyche was put
into action. “Through her untiring efforts a law
for compulsory registration of graduate nurses
was passed in 1903. North Carolina was the first
state in the Union to get this law passed” (Wyche
& Heinzerling, 1938, p. x). With this vision came
change and today NCBON continues to be at the
forefront of nursing regulation in its mission to protect
the public by regulating the practice of nursing.
An example of how North Carolina continues to
influence and facilitate change at the national level
was noted of the September meeting at the National
Council State Boards of Nursing orientation for new
committee Chairs. In order to be selected as a
chair, one has to make application and be selected.
The NCSBON has 12 committees appointed for
2014 and North Carolina has four Board Members
and staff serving as Chairs: Dr. Bobby Lowery chairs
the Distance Learning Education Committee; Julie
George, Executive Director, chairs the Finance
Committee; Dr. Linda Burhans, Associate Executive
Director, chairs the Institute of Regulatory Excellence;
and I have the privilege to chair the Leadership
Academy Committee. Your Board and Board staff
are hard at work making a difference in nursing.
Embracing change and looking to the next three
years, the Board has approved a new strategic plan
for 2014-2017. This plan calls for the Board to focus
on two areas with five initiatives.
I. Enhance Public protection through the Board’s
proactive leadership by:
• Maintaining resources and flexibility to support the
Board’s mission without the use of public funds
• Ensuring equitable, efficient and effective
regulatory processes
• Collaborating with external stakeholders to
address impacts of Affordable Care Act
II. Advance best practices in nursing regulation by
• Implementing evidence-based decision-making to
improve outcomes
• Facilitating innovations in Education and Practice
The timing of the new strategic plan is spot on.
The Affordable Care Act is here and with this new
law comes changes that will affect everyone. On
September 26, 2013 Vice President Joe Biden along
with Health and Human Services Secretary Kathleen
Sebelius held a conference call with nurses across
the US. I joined in this call along with some 3,000
nurses from more than 25 nursing organizations. Vice
President Biden personally thanked nurses across the
country for our work as the country moves to this
change in health care.
Change is in the air!
Dr. Peggy Walters, RN
Chair
Wyche, M.L., & Heinzerling, E.L. (Eds.). (1938). The
history of nursing in north Carolina. Chapel Hill: The
University of North Carolina Press.
http://campaignforaction.org/community-post/
conference-call-vice-president-joe-biden-and-health-and-
human-services-secretary
from the Board Chair
Change is in the Air!
NC
Mary
Lewis
Wyche
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Bulletin Nursing
{ Official Publication of the No r t h Ca r o l i n a Board of Nursing } . . . . . . . . . . . . . . . . . . ELECTION RESULTS FOR 2013
Deborah Herring, Director of Nursing at the Pitt County Health
Department in Greenville, NC was elected as an RN-At-Large to the
NC Board of Nursing. Ms. Herring has more than 37 years of nursing
experience, 29 years of that in the public health field.
Robert Newsom, an LPN with more than 15 years of experience
nursing, was re-elected to the Board to serve a second 4-year term.
North Carolina is the only state in the nation where licensed nurses
elect the majority of their Board. Elections are held every year for specific
slots on the Board. Should you have an interest in running, or know
someone who might, be sure to read the Nomination Form on page 9.
Chair and Vice-Chair elected.
Dr. Peggy Walters, RN was re-elected to Chair the Board for 2014 and
public member, Martha A. Harrell was elected as Vice-Chair for 2014.
New Public Member
Pat Campbell, an experienced nurse, was named to the Board by
N.C. General Assembly Speaker Thom Tillis. Campbell will take the slot
vacated by James Forte who resigned in the Spring.
Results
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Nomination of Candidate for Membership on the North Carolina Board of Nursing for 2014
We, the undersigned currently licensed nurses, do hereby petition for the name of , RN
/ LPN (circle one), whose Certificated Number is , to be placed in nomination as a Member of
the N.C. Board of Nursing in the category of (check one):
o ADN/Diploma Nurse Educator o Staff Nurse o License Practical Nurse
Address of Nominee:
Telephone Number: (Home) (Work)
E-mail Address:
PETITIONER - (At least 10 petitioners per candidate required. Only RNs may petition for RN nominations).
To be postmarked on or before April 1, 2014
Name Signature Certificate Number
Please complete and return nomination forms to 2014 Board Election, North Carolina Board of Nursing, P.O. Box 2129, Raleigh, NC 27602-2129.
Nomination Form for 2014 Election
Although we just completed a succesful Board of Nursing election, we are already getting ready
for our next election. In 2014, the Board will have three openings; one ADN/Diploma Nurse
Educator, one Staff Nurse and one LPN. This form is for you to tear out and use. This nomina-tion
form must be completed on or before April 1, 2014. Read the nomination instructions and
make sure the candidate(s) meet all the requirements.
Instructions
Nominations for both RN and LPN positions shall be made by submitting a completed petition
signed by no fewer than 10 RNs (for an RN nominee) or 10 LPNs (for an LPN nominee) eligible
to vote in the election. The minimum requirements for an RN or an LPN to seek election to the
Board and to maintain membership on it are as follows:
1. Hold a current unencumbered license to practice in North Carolina
2. Be a resident of North Carolina
3. Have a minimum of five years experience in nursing
4. Have been engaged continuously in a position that meets the criteria for the specified Board
position, for at least three years immediately preceding the election.
Minimum ongoing-employment requirements for both RNs and LPNs shall include continu-ous
employment equal to or greater than 50% of a full-time position that meets the criteria for
the specified Board member position, except for the RN at-large position.
If you are interested in being a candidate for one of the positions, visit our website at www.
ncbon.com for additional information, including a Board Member Job Description and other
Board-related information. You also may contact Chandra, Administrative Coordinator, at
chandra@ncbon.com or (919) 782-3211, ext. 232. After careful review of the information
packet, you must complete the nomination form and submit it to the Board office by April 1,
2014.
Guidelines for Nomination
1. RNs can petition only for RN nominations and LPNs can petition only for LPN nominations.
2. Only petitions submitted on the nomination form will be considered. Photocopies or faxes
are not acceptable
3. The certificate number of the nominee and each petitioner must be listed on the form. (The
certificate number appears on the upper right-hand corner of the license.)
4. Names and certificate numbers (for each petitioner) must be legible and accurate.
5. Each petition shall be verified with the records of the Board to validate that each nominee
and petitioner holds appropriate North Carolina licensure.
6. If the license of the nominee is not current, the petition shall be declared invalid.
7. If the license of any petitioner listed on the nomination form is not current, and that
finding decreases the number of petitioners to fewer than ten, the petition shall be declared
invalid.
8. The envelope containing the petition must be postmarked on or before April 1, 2014, for the
nominee to be considered for candidacy. Petitions received before the April 1, 2014, deadline
will be processed on receipt.
9. Elections will be held between July 1 and August 15, 2014. Those elected will begin their
terms of office in January 2015.
Please complete and return nomination forms to 2014 Board Election, North Carolina Board of
Nursing, P.O. Box 2129, Raleigh NC 27602-2129.
Bulletin 10 Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . By Crystal Tillman Harris, DNP, RN, CPNP
The use of social media, including
Facebook, Twitter, LinkedIn, YouTube,
blogs, chat rooms, MySpace and other
similar sites are increasing exponentially.
A 2010 Pew report stated that among
adults, 73% use Facebook, and 14% use
LinkedIn (Pew Report, 2010). The use
of social media will continue to rise and
is a common daily occurrence for most
of us.
Nurses have an added responsibility
of ethical use related to personal use of
social networking. Once again this year,
nurses were ranked highest on honesty
and ethical standards according to the
Gallup poll, as being the most trusted
profession in the United States (Jones,
2011). Nurses have held the number
one spot every year since 1999, with
the exception of 2001 when firefighters
topped the list following the September
11 attacks. As nurses, it is important to
uphold the public’s trust and respect in
all areas of our lives, including the use
of social networking. Therefore, as the
most trusted healthcare professionals,
nurses should not only understand the
use of these technologies, but nurses
should also consider when or where to
use these technologies.
Benefits of Social Networking
It is wonderful to live in an age of
social networking and see the benefits
provided to nurses. As nurses, we
educate our patients and can provide
appropriate websites for patient and
family education. Many nurses use it
as a means of professional networking
and communication with colleagues.
Networking can also disseminate
research and evidence-based practice
findings to colleagues. Smart phones
and tablets have entered the health
care arena and allow easy access of vital
information that can ensure effective
care of the patient. The benefits of
social networking are numerous, and will
increase in the future.
Concerns of Social Networking
With the increase in technology, also
come some concerns for the profession.
Inappropriate sharing of personal or
work information that reflects poorly
on the nurse and professionalism in
nursing is a concern for all of us. Many
times breaches of patient confidentiality
can occur, either intentionally or
inadvertently. Examples include
description of a patient with enough
detail for identification, posting videos
or pictures of patients, and referring
to the patient in a demeaning manner
(ANA, 2011). This can lead to a
breach of patient confidentiality and
privacy and damage to a nurse’s career.
Also of concern is the ability of the
nurse to become distracted while using
smart phones. Such distractions have
the potential to be catastrophic. There
are appropriate uses of technology at
work during patient care…and checking
one’s Facebook status is not one of
them!
Students have been expelled from
nursing school for posting online photos
of themselves with a placenta and nurses
have been fired for discussing patient
cases on Facebook. In the Brynes vs.
Johnson County Community College
litigation, a nursing student posted a
photo of herself with a placenta on her
personal Facebook page. The photo
went viral within hours; the student was
expelled one day later and was told that
she could re-apply to enter the program
the following year. The patient issue
was that in the photo you could see
the student’s ID badge and the school’s
patch on her uniform. By right-clicking
on the photo the embedded date of the
photo is retrievable. Since few babies
were delivered in that hospital that day,
it was easy to “track” and connect the
placenta to the patient. “The Privacy
Rule protects all individually identifiable
health information held or transmitted
by a covered entity or its business
associate, in any form or media, whether
electronic, paper or oral” (Hader, 2010).
Principles for Social
Networking
The National Council of State Boards
of Nursing (NCSBN) and the American
Nurses Association (ANA) have
mutually endorsed each organization’s
guidelines for upholding professional
boundaries in a social networking
environment and have created a joint
webinar on Guidelines for Social Media
(ANA and NCSBN, 2011). The
NCSBN White paper: A nurse’s guide
to the use of social media lists actions
nurses can take to minimize risk and
provides scenarios of unprofessional
behavior based on actual events reported
to Boards of Nursing (NCSBN, 2011).
The ANA publication, Principles
for Social Networking and the Nurse:
Objective
The purpose of this article is to
provide information about social
networking as related to nursing
practice, and enhance the nurse’s
knowledge and application of social
networking
Highlights The use of social
networking can have numerous
benefits but also unintended
consequences for an individual
nurse’s career. Remember that
standards of professionalism are
the same online as in any other
circumstance.
Social Networking and Nurses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Guidance for the Registered Nurse,
is based on the ANA foundational
documents on ethics and standards
of practice (ANA, 2011). A Social
Networking Principles Toolkit consisting
of a fact sheet, tip-card, and poster
is available at no cost on the ANA
website: http://nursingworld.org/
socialnetworkingtoolkit
The American Nurses’ Association
(ANA) has developed a guideline for use
of social media by nurses that includes
principles for social networking that can
lead to appropriate use of the technology
(ANA, 2011). Simply removing a
name or face does not necessarily protect
the patient’s identification. The
principles are:
• Nurses must not transmit or place
online individually identifiable
patient information.
• Nurses must observe ethically
prescribed professional patient-nurse
boundaries.
• Nurses should understand that
patients, colleagues, institutions,
and employers may view postings.
• Nurses should take advantage
of privacy settings and seek to
separate personal and professional
information online.
Nurses should bring content that
could harm a patient’s privacy,
rights, or welfare to the attention
of appropriate authorities. Nurses
should participate in developing
institutional policies governing online
conduct.
The Health Insurance Portability
and Accountability Act (HIPAA)
protection includes information that
can reasonably be used to identify the
patient.
HIPAA’s Dos and Don’ts of Social
Networking:
• Do make a distinction between
your personal life and professional
life online.
• Do use social media for
educational and professional
purposes.
• Do be mindful of HIPAA.
• Do set your privacy settings as high as
possible.
• Don’t be lulled by false security.
• Don’t discuss your patients or your
colleagues.
The Code of Ethics for Nurses provides a
framework for nurses in ethical decision-making
and can provide guidance in the
use of social media (ANA, 2001). The
Code of Ethics for Nurses reminds us of
our primary commitment to patients, to
practice with compassion and respect for
all individuals, and the requirement to
disseminate knowledge (ANA, 2001).
According to the ANA:
The patient’s well-being could be
jeopardized and the fundamental trust
between patient and nurse be destroyed
by unnecessary access to data or by the
inappropriate disclosure of identifiable
patient information. The rights, well-being,
and safety of the individual patient
should be the primary factors in arriving
at any professional judgment concerning
the disposition of confidential information
received from or about the patient,
whether oral, written, or electronic.
NC
continued on page 12 >>>
12 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Consequences for Inappropriate
Use of Social Networking
There are consequences to
inappropriate use of social media. The
potential consequences vary according
to the specific breach of trust. The
incident may be reportable to the North
Carolina Board of Nursing (NCBON).
The NCBON may investigate the nurse
after a report of inappropriate use of
social media on the grounds of (NCSBN,
2011):
• Unprofessional conduct
• Unethical conduct
• Moral turpitude (a evil quality of
behaving)
• Management of patient records
• Revealing a privileged
communication: and;
• Breach of confidentiality
If the NCBON finds the allegations
to be true, the nurse can face disciplinary
action ranging from a reprimand or
sanctions to temporary loss of license.
Thirty-three state BONs reported
complaints last year against nurses who
violated patient privacy using social
media (NCSBN, 2011). In many
cases, the nurse inadvertently breached
confidentiality.
There may be other consequences
also. The nurse may face complaints that
a state or federal law to protect patient
confidentiality was breached. This
violation can result in civil or criminal
charges. There is also the possibility
the nurse could face a lawsuit for
personal damages including defamation
or invasion of privacy. If employment
rules were broken, the nurse may face
suspension or termination at work.
The line between speech protected
by labor laws and the First Amendment
and the ability of an employer to
impose expectations on employees
outside of work is still being determined
(National Labor Relations Board, 2011).
Nonetheless, inappropriate comments
can be detrimental to a cohesive health
care delivery team and may result in
sanctions against the nurse (Cronquist
and Spector, 2011).
Policies
Organizations are finding the need
to develop policies and professional
guidelines to aid nurses in negotiating
responsibly and professionally the use of
social networking. This is beginning to
happen in some medical institutions but
needs more widespread attention in order
to avoid legal and ethical problems.
Managers need to be aware that,
although sending a friend request to
an employee might seem rather fun
and friendly, it could have unintended
consequences. Even if the manager is
comfortable initiating the request, the
employee may not feel the same way,
creating a potentially negative undertone
to their working relationship. It may
lead to potential claims of fraternization,
harassment, or stalking.
Inappropriate social networking should
also be included in nursing education
program curriculums. Discussions of
professional conduct and ethical behavior
in the health care workplace and clinical
settings are necessary. The importance of
social networking must be a priority with
new students during orientation, and the
potential pitfalls social media may create
for nurses.
Most health care employers expect
that the employee will follow the same
behaviors online as they would in face-to-
face contact. Be sure to know the
policies of your employer or academic
institution. Many institutions now have
policies such as:
• Do not “friend” patients
• Do not accept “friend requests” from
patients or their family members
• Never share any patient information
via Facebook or other social media
• Never post pictures of patients or pose
with patients for pictures.
• Never give medical advice via social
media.
Summary
Our online conversation should reflect
the same professionalism that is expected
when working with the public. If you
are about to post an item that you
know would be embarrassing if seen
by a colleague, employer, patient, or
family member, then do not post it. It
is essential to maintain professional
integrity when incorporating networking,
even when doing so only in your personal
life.
Remember once you post something,
there is a digital footprint forever. Just
because you delete a post, photo or video,
does not mean it is destroyed. Data can
be retrievable from law enforcement or
technology experts.
The golden rule in social networking
is this: assume that there is no privacy.
Pretend that what you are writing is
appearing on a permanent billboard. If
you would not want it to be printed for
all to see, then think twice before posting
to a social media site.
Examples of Inappropriate Posts from
Ethical Reasoning and Online Social
Media:
My patient was the cutest little 70-year-old
lady. And I found out she lives in my
neighborhood. Awesome…a new friend.
So far, my clinical sucks…when will I
start doing the fun stuff?
First day off orientation, and I feel
completely overwhelmed! I seriously
don’t know what I’m doing yet. I feel
sorry if you were my patient today…but I
will get better.
The new staffing policy here is awful…
who thought it was OK to have each
nurse have 6 patients. Looks like our
NAs will have to do a lot more!
Friday afternoon….so glad the weekend
is here. Time to get drunk. I need a
vacation from responsibility.
What’s up everyone? I’m on a break
at clinical and had some time to post.
Anybody out there have a minute to
catch up?
I’m going to make sure that I have a
living will. I just don’t understand why
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
the patient I cared for today wants
“everything done” to hang on.
My supervisor was bugging me today
to join ANA. Why would I need to
do that?
(Englund et al., 2012)
References
American Nurses’ Association.
ANA’s Principles for Social
Networking and the Nurse. Silver
Spring, MD, ANA, 2011.
American Nurses’ Association.
Code of Ethics for Nurses
with Interpretive Statements.
Available at: http://nursingworld.
org/MainMenuCategories/
EthicsStandards/
CodeofEthicsforNurses/Code-of-
Ethics.aspx. Accessed July 22, 2013.
American Nurses Association.
Guidelines for using social media.
In: ANA: The American Nurse.
November/December 2011:14.
American Nurses Association and
National Council of State Boards of
Nursing. (2011). ANA and NCSBN
unite to provide guidelines on social
media and networking for nurses.
Available at:
http://www.nursingworld.org/
FunctionalMenuCategories/
MediaResources/PressReleases/2011-
PR/ANA-NCSBN-Guidelines-
Social-Media-Networking-for-Nurses.
aspx. Accessed July 22, 2013.
Bynes vs. JCCCC – Transcript of
the Ruling of the Court, January 24,
2011. Retrieved July 22, 2013 from
www.redstate.com
Cronquist, R., & Spector, N. (2011).
Nurses and Social Media: Regulatory
Concerns and Guidelines. Journal of
Nursing Regulation, Vol 2(3) 37-40.
Englund, H., Chappy, S.,
Jambunathan, J., & Gohdes, E.
(2012). Ethical Reasoning and
Online Social Media. Nurse
Educator, Vol 37(6). 242-247.
Hader, A. & Brown, E. (2010).
Patient privacy and social media.
AANA Journal, 78, 270-274.
Jones, J. Record 64% Rate Honesty,
Ethics of Members of Congress Low:
Ratings of nurses, pharmacists, and
medical doctors most positive. Dec.
12, 2011.
National Council of State Boards of
Nursing. White Paper: A Nurse’s
Guide to the Use of Social Media.
August 2011. Available at: https://
www.ncsbn.org/Social_Media.pdf.
Accessed July 22, 2013.
CAUTION: YouTube and
Competency
Some YouTube videos may be an
excellent educational resource when
a licensed nurse is learning a new
procedure. Since there is a plethora
of videos on YouTube you should use
caution when selecting educational
videos. As you look to see the
expertise of an author when reading
a professional document or article,
so too you should do the same with
YouTube. Always assure the video
content was provided or approved by
a reputable nursing/medical authority.
As well, watching a YouTube
video does not satisfy the
requirements of nursing competency.
Watching a video can be part of a
learning plan, but should never be
an RN’s only resource. The nurse
should also review nursing literature
for knowledge in pathophysiology
and expected and adverse outcomes.
In addition, the nurse should always
be observed completing an activity by
a competent RN or other authorized
licensed healthcare provider to assure
competency.
NC
EARN CE CREDIT
INSTRUCTIONS
Read the article and on-line reference
documents (if applicable). There is not a test
requirement, although reading for comprehension
and self-assessment of knowledge is encouraged.
RECEIVE CONTACT HOUR CERTIFICATE
Go to www.ncbon.com and select “Events,
Workshops & Conferences”; then select “Board
Sponsored Workshops”; under “Bulletin Articles,”
scroll down to the link “Social Networking and
Nurses.” Register, complete and submit the
evaluation, and print your certificate immediately.
Registration deadline is October 1,
2015.
PROVIDER ACCREDITATION
The North Carolina Board of Nursing will
award 1.0 contact hours for this continuing
nursing education activity.
The North Carolina Board of Nursing is
an Approved Provider of continuing nursing
education by the North Carolina Nurses
Association, an accredited approver by the
American Nurses Credentialing Center’s
Commission on Accreditation.
NCBON CNE Contact Hour Activity
Disclosure Statement
The following disclosure applies to the
NCBON continuing nursing education article
entitled “Social Networking and Nurses”:
Participants must read the CE article and
online reference documents (if applicable)
in order to be awarded CNE contact hours.
Verification of participation will be noted by
online registration. No financial relationships
or commercial support have been disclosed by
planners or writers which would influence the
planning of educational objectives and content
of the article. There is no endorsement of any
product by NCNA or ANCC associated with the
article. No article information relates to products
governed by the Food and Drug Administration.
14 Bulletin Nursing
{ Official Publication of the No r t h Ca r o l i n a Board of Nursing } . . . . . . . . . . . . . . . . . . Nurses are key players in leading and designing safe
healthcare delivery systems. As healthcare delivery systems
evolve to provide more cost-effective models of care, the
nurse’s delegation of tasks and activities to unlicensed assistive
personnel (UAP) is anticipated to increase. As the need
for delegation to a variety of UAP escalates, the registered
nurse (RN) and licensed practical nurse (LPN) must continue
to develop and utilize efficient, effective decision-making
knowledge and critical thinking skills to ensure the delivery of
safe client care.
In January, 2013, the Board of Nursing’s (NCBON)
Education and Practice Committee was charged “To review
Registered Nurse (RN) and Licensed Practical Nurse (LPN)
delegation of nursing activities to Unlicensed Assistive
Personnel (UAP), including medication administration,
across diverse healthcare settings to proactively promote safe,
effective care, maximizing the capabilities of licensed nurses
and unlicensed care providers.” In moving forward with the
charge, the Education and Practice Committee developed a
new version of the NCBON Decision Tree for Delegation to
UAP. This new version was approved by the Board of Nursing
on September 20, 2013 for immediate implementation by all
RNs and LPNs in all practice settings across the state.
The purpose of the NCBON Decision Tree for Delegation
to UAP is to support nurses in making appropriate decisions
when delegating nursing tasks or activities to UAP. The
Nursing Practice Act (NPA) and Administrative Code
(Rules) define delegation as a component of the scope of
practice for both the RN and LPN, and specify the criteria
that must be in place for appropriate nursing delegation to
UAP. Delegation requires nursing judgment and decision-making
based on four essential steps as detailed in the new
version of the NCBON Decision Tree for Delegation to
UAP: Assessment and Implementation; Communication;
Supervision and Monitoring; and Evaluation and Feedback.
Effective nursing delegation of tasks/activities to UAP
depends upon the nurse’s abilities and skills to make
appropriate delegation decisions. Delegation is a client and
situation specific activity in which the nurse, RN or LPN,
must consider all the components of the delegation process
for each delegation decision. All nurses are encouraged to
review and use the NCBON Decision Tree for Delegation
to UAP as a framework to promote effective delegation and
ensure quality care is delivered. Delegation is a skill developed
through education and practice. The Board of Nursing
encourages nursing employers, directors, and managers to
establish delegation resources that are easily accessible to all
nurses. Effective delegation supports the NCBON mission to
protect the public by regulating the practice of nursing.
The new version of the NCBON Decision Tree for
Delegation to UAP is located on the Board of Nursing website
at www.ncbon.com, under the “Nursing Practice” heading,
subheading “Position Statements and Decision Trees”, and
“Decision Tree for Delegation to UAP.”
New Delegation Decision
Tree for Nurses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Is the task within the scope of practice for a licensed nurse (RN/LPN)? No Stop! Do not delegate to UAP.
Yes
Is RN assessment of client’s nursing care needs complete? Stop! RN to complete assessment, then proceed
with consideration of delegation.
Is the RN/LPN competent to make delegation decisions? Nurse is accountable for the decision to delegate, to
implement the steps of the delegation process, and to assure that the delegated task is appropriate based on
individualized needs of each client which includes stability, absence of risk of complications, and predictability
of change in condition. The delegating nurse must be competent to perform the activity. See (A) and (B) pg. 2
Stop! Do not
delegate to UAP.
Is the task consistent with the rules for delegation to UAP? Must meet all the following criteria:
􀂃􈍆 Frequently recurs in the daily care of a client or group of clients
􀂃􈍉 Is performed according to an established sequence of steps
􀂃􈍉 Involves little to no modification from one client care situation to another
􀂃􈍍 May be performed with a predictable outcome
􀂃􈍄 Does not inherently involve ongoing assessment, interpretation, or decision making which cannot be
logically separated from the procedure(s) itself; and
􀂃􈍄 Does not endanger the client’s life or well being.
Stop! Do not
delegate to UAP.
Stop! Do not proceed without evaluation of need for
policy, procedures and/or protocol or determination that it
is in the best interest of the client to proceed with
delegation in urgent or emergency situations.
Is appropriate supervision available? See (C) (D) (E) pg. 3 Stop! Do not delegate to UAP.
No
Yes
No
Yes
No
Yes
Are there written agency policies, procedures, and/or protocols in
place for this task?
No
No
Yes
Yes
No Stop! Do not delegate to UAP.
Yes
No
Does the capability of UAP match the care needs of the client?
See (A) and (B) pg. 2 No
Step 1 of 4: Assessment and Implementation
The UAP is responsible for accepting the delegation, seeking clarification of and affirming expectations,
performing the task correctly and timely communicating results to the nurse. Only the implementation of a
task/activity may be delegated. Assessment, planning, evaluation and nursing judgment cannot be delegated.
Delegation is a client and situation specific activity in which the nurse must consider all components of the
delegation process for each delegation decision. Specific direction by the nurse (RN, LPN) to UAP when
assisting the nurse with a task or nursing activity and under the direct visual supervision of the nurse is not
considered delegation.
Yes
Is the UAP properly trained and validated as competent by an RN
to accept the delegation?
Stop! Do not delegate until evidence of education
and validation of competency available, and then
reconsider delegation; otherwise do not delegate.
Proceed with delegation.
P.O. BOX 2129
Raleigh, NC 27602
DECISION TREE FOR DELEGATION TO UAP (919) 782-3211
FAX (919) 781-9461
Nurse Aide II Registry (919) 782-7499
www.ncbon.com
Is the activity allowed by the Nursing Practice Act, Board
Rules, Statements, or by any other law, rule or policy?
Stop! Do not delegate until the nurse has evaluated
capability of UAP matches the care needs of the
client.
Page 1 of 3
16 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
IMPORTANT COMPONENTS FOR DELEGATION TO UAP
Prior to proceeding to Step 2, consider the following:
Delegation is a process of decision-making, critical thinking and nursing judgment. Decisions to delegate nursing tasks/activities to UAP are based on the RN’s
assessment of the client’s nursing care needs. The LPN may delegate nursing tasks/activities to UAP under the supervision of the RN. Additional criteria that
must be considered when determining appropriate delegation of tasks include, but are not limited to:
(A) Variables:
􀂃􈍋 Knowledge and skill of UAP
􀂃􈍖 Verification of clinical competence of UAP
􀂃􈍓 Stability of the client’s condition which involves predictability, absence of
risk of complication, and rate of change
􀂃􈍖 Variables specific for each practice setting:
o The complexity and frequency of nursing care needed by a
given client population
o The proximity of clients to staff
o The number and qualifications of staff
o The accessible resources
􀂃􈍅 Established policies, procedures, practices, and channels of communication
which lend support to the types of nursing activities being delegated, or not
delegated, to UAP
(B) Use of critical thinking and professional judgment for The Five Rights of
Delegation:
1. Right Task – the task must meet all of the delegation criteria
2. Right Circumstance – delegation must be appropriate to the client
population and practice setting
3. Right Person – the nurse must be competent to perform the activity
and to make delegation decisions, the nurse must ensure the right
task is being delegated to the right person (UAP) and competence
has been validated by an RN, and the delegation is for the
individualized needs of the client
4. Right Communication – the nurse must provide clear, concise
instructions for performing the task
5. Right Supervision – the nurse must provide appropriate
supervision/monitoring, evaluation, and feedback of UAP
performance of the task
Step 2 of 4: Communication - Communication must be a two-way process
The nurse:
􀂃􈍁 Assesses the UAP’s understanding of:
o Task to be performed and expectations of performance of tasks
o Information to report including client specific observations, expected
and concerns
o When and how to report/record information
􀂃􈍃 Communicates Individualized needs of client population, practice
setting, and unique client requirements
􀂃􈍃 Communicates and provides guidance, coaching, and support for UAP
􀂃􈍁 Allows UAP opportunity for questions and clarification
􀂃􈍁 Assures accountability by verifying UAP accepts delegation
􀂃􈍄 Develops and communicates plan of action in emergency situations
􀂃􈍄 Determines Communication method between nurse and UAP
The UAP:
􀂃􈍁 Asks questions and seeks clarification
􀂃􈍉 Informs the nurse if UAP has not performed the
task or has performed it infrequently
􀂃􈍒 Requests additional training or guidance as
needed
􀂃􈍁 Affirms understanding and acceptance of
delegation
􀂃􈍃 Complies with communication method between
nurse and UAP
􀂃􈍒 Reports care results to nurse in a timely manner
􀂃􈍃 Complies with emergency action plans
Documentation by nurse and
UAP
(as determined by facility/agency
policy) is:
Timely, complete and accurate
documentation of provided care:
􀂃􈍆 Facilitates communication with
other members of the health care
team
􀂃􈍒 Records the nursing care
provided.
Page 2 of 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Step 3 of 4: Supervision and Monitoring – The RN supervises the delegation by monitoring the performance of the task and assures
compliance with standards of practice, policies and procedures. The LPN supervision is limited to on-the-job assurance that tasks have
been performed as delegated and according to standards of practice established in agency policies and procedures. Frequency, level,
and nature of monitoring vary with the needs of the client and experience of the UAP.
(C) The nurse takes into consideration the:
􀂃􈍃 Client’s health stability, status, and acuity
􀂃􈍐 Predictability of client response to interventions
and risks posed
􀂃􈍐 Practice setting and client population
􀂃􈍁 Available resources
􀂃􈍃 Complexity & frequency of nursing care needed
􀂃􈍐 Proximity of clients to staff
􀂃􈍎 Number and qualification of staff
􀂃􈍐 Policies, procedures, & channels of
communication established
(D) The nurse determines:
􀂃􈍔 The amount/degree of supervision required
􀂃􈍔 Type of supervision: direct or indirect
􀂃􈍔 The Five Rights of Delegation have been
implemented:
1. Right Task
2. Right Circumstances
3. Right Person
4. Right Directions and Communications
5. Right Supervision and Evaluation
(E) The nurse:
􀂃􈍍 Maintains accountability for nursing tasks/activities
delegated and performed by UAP
􀂃􈍍 Monitors outcomes of delegated nursing care tasks
􀂃􈍉 Intervenes and follows-up on problems, incidents, and
concerns within an appropriate timeframe
􀂃􈍎 Nursing management and administration
responsibilities are beyond LPN scope of practice. To
assure client safety, the LPN may need authority to
alter delegation or temporarily suspend UAP per
agency policy until appropriate personnel action can be
determined by the supervising RN.
􀂃􈍏 Observes client response to nursing care and UAP’s
performance of care
􀂃􈍒 Recognizes subtle signs and symptoms with
appropriate intervention when client’s condition
changes
􀂃􈍒 Recognizes UAP’s difficulties in completing
delegation activities
Step 4 of 4: Evaluation and Feedback – Evaluate effectiveness of delegation and provide appropriate feedback
􀂃􈍅 Evaluate the nursing care outcomes:
o (RN) Evaluate the effectiveness of the nursing plan of care and modify as needed
o (LPN) Recognize the effectiveness of nursing interventions and propose modifications to plan of care for review by the RN
􀂃􈍅 Evaluate the effectiveness of delegation:
o Task performed correctly?
o Expected outcomes achieved?
o Communication was timely and effective?
o Identify challenges and what went well
o Identify problems and concerns that occurred and how they were addressed
􀂃􈍐 Provide feedback to UAP regarding performance of tasks/activities and acknowledge the UAP for accomplishing the task
References:
G.S. 90-171.20 (7)(d) & (i) and (8) (d) Nursing Practice Act American Nurses Association Decision Tree for Delegation by Registered Nurses, 2012
21 NCAC 36.0221 (b)Licensed Required Joint Statement on Delegation ANA and NCSBN Decision Tree for Delegation to Nursing
21 NCAC 36.0224 (a) (b) (c) (d) (e) (f) (i) & (j) Components of Practice for the Registered nurse Assistive Personnel, 2005
21 NCAC 36.0225 (b) (c) (d) (e) (f) Components of Practice for the Licensed Practical Nurse National Council of State Boards of Nursing Decision Tree – Delegation to Nursing Assistive
21 NCAC 36.0401 (c) Roles of Unlicensed Personnel Assistive Personnel, 2005
Page 3 of 3 Origin: 5/2000; Revised 4/2007; Reviewed 2/2013; Revised 9/2013
18 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The Board of Nursing receives many
questions from individuals who are
exploring nursing education originating
from out-of-state. If you are interested
in attending an out-of-state nursing
program, please read these FAQs.
Is the NCBON imposing restrictions
on out-of-state nursing education
programs? I am being told by an out-of-
state program that the NCBON is
preventing them from admitting NC
residents as students.
The NCBON is not imposing
restrictions on out-of state nursing
education programs. There is, however,
a law in NC which requires ANY out-of-
state program that conducts ANY
educational activities in NC (including
on-line programs, correspondence
courses, and student clinical experiences)
to be licensed by the University of
North Carolina (UNC) System General
Administration/Board of Governors.
This is required by a law not associated
with the NC Board of Nursing, but
rather with the UNC System. When
considering enrollment in ANY out-of-
state nursing program, individuals
should check with the UNC System
to verify licensure status by calling
919-962-4558 or on the UNC System
website at: http://www.northcarolina.
edu/aa planning/licensure/licensed.htm
Does the NCBON approve nursing
graduate-level (masters and doctoral)
out-of-state programs/online programs/
correspondence courses?
The NCBON does not approve
or disapprove graduate-level nursing
programs, in-state, nor out-of-state,
regardless of teaching methodologies
used. Programs over which the
NCBON does NOT have jurisdiction
include: RN-BSN, masters, and
doctoral programs. While some states
do have jurisdiction over programs
beyond those leading to initial
licensure, the NCBON does not. The
NCBON has jurisdiction only over pre-licensure
nursing programs located in
NC that prepare graduates to take the
initial LPN or RN licensure examination
If I attend a nursing education
program in another state, am I able
to complete my student clinical
experiences in NC?
a) Pre-licensure (RN or LPN)
students who are attending out-of-
state programs and wish to
complete clinical experiences in
North Carolina must contact the
NCBON by email at education@
ncbon.com to obtain information
regarding requirements.
b) Graduate (master’s or doctoral)
students who do not hold a NC
or multistate nursing license
must contact the NCBON by
email at practice@ncbon.com
to obtain information regarding
requirements for the completion
of clinical experiences in NC.
c) Graduate (master’s or doctoral)
students who hold a NC or
multistate nursing license may
seek clinical experiences in NC
without NCBON notification or
approval.
(NOTE: The UNC System requires
that all out-of-state degree granting
institutions be licensed as described in
the above question. Although not an
NCBON requirement, all students are
urged to ascertain their institution’s NC
licensure status.)
ERQUAEIMRttentionN: T A rves Y.o EFOPRu InteresSteSdIO inN aAILn SM
Out-of-State Nursing Program?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Administrative Maters
• Approved revisions to Vision and Values
Statements as follows:
Vision: The NCBON excels in advancing public
protection in a dynamic healthcare environment.
Values: Setting the PACE for Public Protection
and Regulatory Excellence
Professionalism
Accountability
Commitment
Equity/Fairness
• Approved 2014 – 2017 Strategic Plan
Strategic Initiative #1: Enhance public protection
through the Board’s proactive leadership by
a. Maintaining resources and flexibility to sup-port
the Board’s mission without the use of
public funds
b. Ensuring equitable, efficient and effective
regulatory processes
c. Collaborating with external stakeholders
to address impacts of Health Care Reform
Strategic Initiative #2: Advance best practices
in nursing regulation by
a. Implementing evidence-based decision-making
to improve outcomes
b. Facilitating innovations in Education and
Practice
Investigation and Monitoring
Actions
Received reports and Granted Absolutions to 3
RNs and 1 LPN
Removed probation from the license of 19 RNs
and 4 LPNs
Accepted the Voluntary Surrender from 12 RNs
and 2 LPNs
Suspended the license of 13 RNs and 4 LPNs
Reinstated the license of 16 RNs and 2 LPN
Number of Participants in the Alternative
Program for Chemical Dependency: 158 RNs
and 8 LPNs (Total = 166)
Number of Participants in the Chemical
Dependency Program (CDDP): 87 RNs, 8 LPNs
(Total = 95)
Number of Participants in Illicit Drug and Alcohol/
Intervention Program: 25 RNs, 10 LPNs. (Total
= 35)
Education maters:
Ratification of Full Approval Status – 10 programs
Determination of Program Approval Status – 1
program
Ratification of Program Expansion – 1 program
ACEN/CCNE Accreditation Decisions – 9 pro-grams
SUMMARY of
Activities
20 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Calling All RNs, LPNs, Nursing
Managers, and Nursing Faculty!
Opportunities Available for YOU!
The National Council of State Boards
of Nursing (NCSBN) wants YOU
to participate in the development of
the NCLEX-RN® and NCLEX-PN®
examinations. The Item Development
Program is a key component in
maintaining high quality NCLEX®
items.
NCSBN depends on practicing
nurses to assist in the NCLEX® item
development process. Nurses may
be selected to be item writers or item
reviewers. If you are selected to serve as a
member, you will:
• Contribute to continued excellence
in the nursing profession;
• Have opportunities to network on a
national and international level;
• Build new skills that are useful in
your current position, as well as for
professional growth; and
• Earn continuing education contact
hours.
Item writers create the questions
that are administered in the NCLEX®
examinations. You must be responsible
for teaching basic/undergraduate students
in the clinical area and must have a
master’s degree or higher (for the RN
exam only). Item reviewers examine the
items that are created by item writers.
You must have at least 2 years experience
and be currently employed in clinical
nursing practice AND working directly
with nurses who have entered nursing
practice during the past 12 months,
specifically in a precepting or supervising
capacity.
More information and an application
are available on NCSBN’s website
at www.ncsbn.org/1227.htm . If all
qualifications are met, NCSBN will
obtain approval from the NCBON.
Applications remain active for a two-year
period from the date of initial submission.
NCSBN will notify you when you are
considered for a specific panel in which
you will participate for three to five
days. Sessions are held throughout the
year in Chicago and your travel expense,
including lodging and meals, will be
covered.
If you prefer, you can send an e-mail
with your complete contact information
and listing your current employer
and supervisor to Burnette Brown at
bbrown@ncbon.com . The NCBON
will maintain your contact information
and inform you when NCSBN is seeking
applicants for specific panels.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Face-to-face workshop with Board of Nursing
consultants
If you are a chief nurse administrator or mid-level
nurse manager who would like to learn
about the functions of the Board of Nursing
and how these functions impact your role in all
types of nursing service settings, please consider
registering online for one of the following 2014
orientation sessions.
Go to: www.ncbon.com – Nursing Education -
Continuing Education – Board Sponsored
Offerings.
Scroll down the page until you see “On-Site
Workshop.”
Register for one of the following dates ($40
fee).
February 12, 2014 - Wednesday
April 9, 2014 - Wednesday
September 17, 2014 - Wednesday
November 6, 2014 - Thursday
All sessions are held at the North Carolina
Board of Nursing office in Raleigh, NC from 10
a.m. until 4 p.m.
If you attend the entire session, you will
be presented with 4.6 continuing nursing
education contact hours.
Participants must attend the entire session(s) in
order to earn contact hour credit. Verification
of participation will be noted by signature
on the roster. A completed evaluation form
must be returned. Planners and presenters
have declared that they have no conflict of
interest or financial relationships which would
influence the planning of this activity. If any
are discovered during the course of the activity,
an announcement will be made to inform the
participants. No commercial support, product
endorsements or products governed by the Food
and Drug Administration have been identified
for this activity.
The North Carolina Board of Nursing is an
approved provider of continuing nursing
education by the North Carolina Nurses
Association, an accredited approver by the
American Nurses Credentialing Center’s
Commission on Accreditation.
Orientation Sessions
for Administrators
of Nursing Services
and Mid-Level Nurse
Managers
22 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The 2013 recipient of the Board of Nursing Employee Excel-lence
Award is Kathy Chastain, RN, MN,FRE, Associate Direc-tor
Regulation/Quality.
Chastain has demonstrated an outstanding commitment to
the growth and development of staff. Also, by serving as the
Quality expert to the Administrative Council, she has worked to
develop guidelines and measurement outcomes throughout the
organization.
As the supervisor of the Board’s investigative staff, Chastain
is a role model in the use of the “Just Culture” principles and has
lead the way to incorporate this philosophy into the culture of
Board staff. Based upon the outcomes of investigations --- under
Chastain’s leadership – the National Council of State Boards
of Nursing (NCSBN) have identified North Carolina as hav-ing
“best practices” in the core data submitted for review of all
member Boards. Chastain has participated in NCSBN meetings
to share her experience in implementing changes in our investi-gative
department under her leadership.
Recently, Chastain was interviewed by an investigative re-porter
from the Atlanta Journal Constitution regarding the cycle
times of case resolutions in North Carolina as compared to our
neighboring state to the South.
The Employee Excellence Award is especially meaningful, as
it recognizes the achievement of a Board Staff member who has
been nominated by their peers.
Please join the both the staff and the members of the North
Carolina Board of Nursing in congratulating Kathy Chastain as
the recipient of this year’s Employee Excellence Award.
Chastain recipient of Employee
Excelence Award
Kathleen Privette, RN,MSN, FRE Manager of Drug Moni-toring
Programs for the North Carolina Board of Nursing,
has completed The Institute of Regulatory Excellence (IRE)
Fellowship program sponsored by the National Council of
State Boards of Nursing (NCSBN). The four year professional
development program is designed for regulators to enhance
their knowledge of leadership in nursing regulation.
The program requires that each candidate complete a
project that contributes to the science of nursing regulation.
Privette’s research focused on attrition rates among nurses
enrolled in the Board’s Alternative Program for Chemical
Dependency.
The North Carolina Board of Nursing is proud to have 6 of
the 39 designated Fellows.
Privette completes Regulatory Fellowship
Licensure Review Panels
• Nov. 14, 2013
• Dec. 12, 2013
• Jan. 14, 2014
• Feb. 13, 2014
Administrative Hearing
• Dec. 13, 2013
• Feb. 6, 2014
Education/Practice
Comite
• Dec. 4, 2013
• Mar. 26,2014
Board Meting
• Jan. 23-24, 2014
North Carolina Board
of Nursing Calendar
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Online Bulletin
Articles
Webcasts
Social Networking and
Nurses
(1.0 CH)
No fee required
Delegation: What are
the Nurse’s
Responsibilities?
(2 CHs)
No fee required
Continuing Competence
Self Assessment: Have
You Met Your
Professional
Responsibility?
(1 CH)
No fee required
Competency Validation:
What Does it Mean for
You?
(.75 CH)
No fee required.
Public Protection
Through Safe Nurse
Staffing Practice
(.85 CH)
No fee required.
Incivility in Nursing
(1 CH)
No fee required.
Fitness for Duty
Includes Getting
Your ZZZZs
(1 CH)
No fee required.
Understanding the
Scope of Practice and
Role of the LPN (1 CH)
Provides information
clarifying the LPN scope
of practice. An important
course for RNs, LPNs,
and employers of LPNs.
No fee required.
LEGAL SCOPE OF
PRACTICE
(2.3 CHs)
Provides information
and clarification regarding
the legal scope of practice
parameters for licensed
nurses in
North Carolina.
$40.00 Fee.
Questions:
Pamela Trantham
919-782-3211 ext. 279
Pamela@ncbon.com
To access online CE articles, webcasts,
session registration, and the
presentation request form, go to:
www.ncbon.com Click on:
to the right of the homepage.
Questions on Online Bulletin Articles
Contact:: Linda Blain
919-782-3211 ext. 238 LindaB@ncbon.com
For Webcasts and Orientation Session see
bottom of columns for contact info.
Face-to-face workshop at
NC Board of Nursing
office.
Information session
regarding the functions of
the Board of Nursing and
how these functions
impact the roles of the
nurse administrator
and the mid-level nurse
manager in all types of
nursing services.
Session Dates
November 6, 2013
$40.00 fee (non-refundable
unless
session is canceled)
Register online at
www.ncbon.com.
Registration at least two
weeks in advance of a
scheduled session
is required.
Seating is limited. There
is usually a waiting list for
this workshop. If you are
unable to attend and do
not have a substitute to
go in your place, please
inform the NCBON so
someone on the waiting
list can attend.
PAPER REGISTRATION
REQUEST, CONTACT
PAULETTE HAMPTON
919-782-3211 EXT 244
Orientation Session
PRACTICE CONSULTANT AVAILABLE TO PRESENT AT YOUR FACILITY!
An NCBON practice consultant is available to provide educational presentations upon request from agencies or organizations.
To request a practice consultant to speak at your facility, please complete the Presentation Request Form online
and submit it per form instructions. The NCBON will contact you to arrange a presentation.
Standard presentations offered are as follows:
• Continuing Competence (1 CH) – 1 hour - Presentation is for all nurses with an active license in NC and is an overview of continuing
competency requirements.
• Legal Scope of Practice (2.0 CHs) – 2 hours – Defines and contrasts each scope, explains delegation and accountability of nurse with
unlicensed assistive personnel, and provides examples of exceeding scope. Also available as webcast.
• Understanding the Scope of Practice and Role of the LPN (1 CH) - 1 hour - Assists RNs, LPNs, and employers of nurses in
understanding the LPN scope of practice. Also available as webcast.
• Documentation and Medication Errors (1 CH) – 1 hour – Explains purpose, importance, and desirable characteristics of documentation;
describes relationship between nursing regulation and documentation; identifies practices to avoid and those that may violate NPA; and
identifies most common medication errors and contributing factors.
• Nursing Regulation in NC (1 CH) – 1 hour – Describes Board authority, composition, vision, function, activities, strategic initiatives, and
resources.
• Introduction to Just Culture and NCBON Complaint Evaluation Tool (1.5 CHs) – 1 hour and 30 minutes - Provides information about
Just Culture concepts, role of nursing regulation in practice errors, instructions in use of NCBON CET, consultation with NCBON about
practice errors, and mandatory reporting. Suggested for audience NOT familiar with Just Culture.
• Introduction to the NCBON Complaint Evaluation Tool (1 CH) – 1 hour - Provides brief information about Just Culture concepts and
instructions for use of the NC Board of Nursing’s Complaint Evaluation Tool, consultation with NCBON about practice errors, and
mandatory reporting. Suggested for audience already familiar with Just Culture.
The North Carolina Board of Nursing is an approved provider of continuing nursing education by the North Carolina Nurses
Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
24 Bulletin Nursing
The NC Department of Health and
Human Services implemented the
Controlled Substances Reporting System
(CSRS) six years ago to monitor outpa-tient
dispensing of prescription con-trolled
substances on a statewide basis.
The system is authorized by a 2005 state
law, which clearly states the CSRS’s
purpose: To “improve the State’s ability
to identify controlled substance abusers
or misusers and refer them for treat-ment,
and to identify and stop diversion
of prescription drugs in an efficient and
cost-effective manner that will not im-pede
the appropriate medical utilization
of licit controlled substances.”
The law requires all outpatient
dispensers of controlled substances
in North Carolina to regularly report
prescription data to the CSRS. Eligible
practitioners (medical practitioners must
hold either a valid DEA registration or a
valid pharmacist’s license to view data)
may register for access to the system,
for the purpose of viewing individual
patients’ prescription profiles.
Since the system went live in July
2007, more than 17,500 physicians,
physician assistants, nurse practitioners
and other prescribers have signed up to
access CSRS data, and that number is
growing every week.
Q & A
Under what circumstances might a
physician check a patient’s prescription
profile with the CSRS?
They should be doing it to provide
pharmaceutical or medical care for their
patient.
What information would a query to the
CSRS on a particular patient return?
It would indicate the date a prescrip-tion
was dispensed, the amount dis-pensed,
whether it was a refill or a new
prescription, the number of refills, the
pharmacy where it was dispensed and the
practitioner who wrote the prescription.
It will also indicate the patient’s name
and address.
How should physicians and other pre-scribers
be using this data?
To provide comprehensive medical
or pharmaceutical care for their patient.
If the data reveal that the patient may
be seeking large quantities of controlled
substances or seeking prescriptions from
multiple providers, then the practitioner
should discuss this with the patient and
offer help.
Are you aware of situations where
prescribers are using data obtained
through the system to “fire” a patient?
Yes, not only to fire a patient, but
to exclude. We’ve heard of a couple
of situations where a pain manage-ment
specialist decides that a patient is
doctor-shopping and, based on what he
sees in the CSRS, decides not to take
on that patient. That is not an appropri-ate
use of the system. We’ve also heard
of numerous cases where, based on the
data, physicians have dismissed an estab-lished
patient. I don’t mean to suggest
that they can’t or shouldn’t do that. But
there’s a right and a wrong way to do it.
It’s complicated. First, we’ve had several
instances where the data has been wrong
and the patient has been right and the
physician hasn’t believed the patient.
And potential harm may come to the
patient when a physician decides to ex-clude
them. The fact that they’ve been
labeled or branded as a doctor-shopper
follows them and then other physicians
decide not to take them on.
What would be a preferable response?
If a patient is starting to see different
doctors, the physician can establish an
agreement or contract with the patient
that he only sees one physician or that
he notify and get approval from his
physician to see another physician. If
that contract is violated, you don’t need
to throw the patient out. It may be an
opportunity to expand the care. Maybe
refer that patient to more specialized
care or to a substance abuse program,
that kind of thing. Would you dismiss
a cardiac patient for not following his
or her diet? You’re going to have some
patients who after trying to intervene
and refer them for care and documenting
Prescription data reported to CSRS
continued on page 26
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
26 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
those efforts may still have to be dismiss
ed.
But it shouldn’t be the first action you
take.
Correct. You may be able to use the
data to take a different approach. For
example, an emergency room doctor who
checked on a patient may say, ‘I don’t
want to give this person an opiate. I’m go-ing
to give them something else because
they’ve gotten a lot of opiates.’ It can be
useful in deciding what kind of treatment
you’re going to provide.
What if a patient claims that the in-formation
the CSRS has on them is not
accurate?
Sit down and discuss it with the
patient. Either the doctor or the patient
can contact the NC CSRS Staff and we
can help sift through what is accurate and
what is inaccurate in the system. Don’t
just assume that it’s a doctor shopper and
because he has a substance use problem,
he’s lying. He might be, but he might not
be. We’ve had too many occasions where
either there’s been a mistaken identity
or the dispensing pharmacy has loaded
up the wrong DEA number so the wrong
prescriber is on there, or other things like
that. Give the patient the benefit of the
doubt, at least the first time. Then inform
the patient you are going to follow them
very closely.
Could you go over the protocols for
accessing the CSRS? Who is authorized,
within a medical practice, to access the
system?
The prescriber or dispenser. Only the
person with that log on, not their nurse,
not their office manager, not another
prescriber. Each practitioner in the office
has to have their own login.
Beginning in 2014 we will be allow-ing
delegate accounts where an already
approved user may delegate the task of
running queries to someone else in the
office. This delegate will apply online and
be given their own individual username
and password. Never share your username
and password with anyone.
There’s another practice I see doctors
doing that is unlawful, and that is calling
up the police. You can’t do that. You can-not
release this data to the police.
Is there anything else you’d like to
mention that you feel is important for
physicians and other prescribers to un-derstand
about the CSRS?
We would eventually like to see this
become a standard of care in prescribing
controlled substances. Our hope is that
checking the system becomes an accepted
part of practice. A physician would not be
doing his or her best if they didn’t check
the system. The other message is that this
needs to be seen as a tool. It’s one piece of
the puzzle just like an X-ray or a lab test
or anything else. And it should be used
in combination with all the other stuff.
Physicians should not be relying on it as
a standalone item when making patient
care decisions. We hope this tool can as-sist
a physician in providing appropriate
care for the patient, including a referral
for treatment if indicated.
Anything else?
If you’re using the system, tell your
patients you’re doing it. Don’t do it
behind the patient’s back. Also, to help
prescribers become more comfortable
with addressing issues with patients sug-gest
learning more about SBIRT, which
stands for Screening, Brief Intervention
and Referral for Treatment. This is now a
billable service. You can learn more about
SBIRT by visiting www.sbirtnc.org.
Sign up to use the system
Clinicians who want to check a pa-tient’s
controlled substances prescription
profile must register for access with the
NC Controlled Substances Reporting Sys-tem.
To qualify, you must be authorized to
prescribe or dispense controlled substanc-es
for the purpose of providing medical or
pharmaceutical care for patients.
How do I sign up for access?
Download and complete a short enroll-ment
application from the CSRS website.
Please note that the form must be nota-rized
and mailed with a copy of a photo
ID and signed copy of a privacy statement
to the CSRS. Approved applicants will be
notified via e-mail, typically within two
weeks.
Once I get access, who in my practice
may use my login to query the CSRS
database?
Because of strict confidentiality provi-sions
in the law, only the registered prac-titioner
may access the system. The law
prohibits other members of the practice
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
from using without their own username
and password.
How often is the database updated?
State law requires outpatient
dispensers of controlled substances to
report prescription data to the CSRS
once every 7 days so it may take up to
two weeks for a prescription to show
up in the system. Beginning on Janu-ary
1, 2014 pharmacies will be required
to report every 72 hours with 24 hour
reporting highly encouraged. This will
greatly reduce the lag time.
What if I have concerns about accura-cy
of the data, or a patient questions
its validity?
Contact John Womble at the Divi-sion
of Mental Health, Developmental
Disabilities and Substance Abuse Ser-vices,
Drug Control Unit at 919-733-
1765, Monday through Friday between
9 a.m. and 5 p.m.
This article was contributed by
the NC Department of Health and
Human Services – Division of Mental
Health, Developmental Disabilities
and Substance Abuse Services.
28 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Do You Have a Sponsor – NCBON’s Update on Third Party
Payments
Trends in technology are leading NCBON, Pearson Vue and
NCSBN to a paperless trail, beginning October 2013. As part of
our commitment to reducing paper usage, the NCBON is launching
a new database system, and will continue to digitize reports, forms,
and other documents. In efforts to operate more effectively, the
NCBON updated policies in reference to third party payments.
What does this mean for perspective NCLEX candidates and their
sponsors? The NCBON will still welcome third party payments,
but the manner in which the NCBON receives and processes these
payments will differ from those in previous years.
Below are the new time lines and payment methods for sponsors:
October 5th, 2013 – NCBON will no longer accept paper
applications
• Candidates complete the Nurse Gateway Registration & the
online application
• Third party payees will submit payment to the NCBON
(company check, certified check, money order, credit/debit
card) with the applicants information attached
• Once payments clear the candidate’s account will be activated
January 1st, 2014 – NCSBN will no longer accept paper
registrations for testing through Pearson Vue
• Candidates will complete the registration through Pearson
Vue at www.pearsonvue.com
• Third party payees will be required to pay fees with a debit/
credit card or a prepaid VISA or MasterCard gift card, these
will be the only payment methods accepted
NCBON and NCSBN encourages program educators, private/
government agencies, and other sponsors to seek and secure payment
methods that will comply with the latest technology upgrades.
NCBON, Pearson Vue and NCSBN
to go paperless
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Nurse Network
Economical Classifieds (1.5” wide x 1” high)
Reach every nurse in North Carolina for as little as $290.
RESERVE YOUR SPACE NOW!
Contact Victor Horne: vhorne@pcipublishing.com 1-800-561-4686
31
Presorted Standard
U.S. Postage Paid
Little Rock, AR
P.O. Box 2129 Permit No. 1884
Raleigh, NC 27602-2129

www.ncbon.com
FALL 2013 VOLUME 10 {NO 1} EDITION 28
Bulletin Nursing
{Official Publication of the North Carolina Board of Nursing}
www.ncbon.com
Social Networking
and Nurses
Page 10
2 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
FALL 2013 BULLETIN
NC BOARD OF NURSING
Nursing Bulletin is the official
publication of the North
Carolina Board of Nursing.
Office Location
4516 Lake Boone Trail
Raleigh, NC 27607
Mailing Address
P.O. Box 2129
Raleigh, NC 27602
Telephone
(919) 782-3211
Fax
(919) 781-9461
Automated Verification
(919) 881-2272
Website
www.ncbon.com
Office Hours
8 a.m. to 5 p.m.,
Monday through Friday
Board Chair
Dr. Peggy C. Walters, RN
Executive Director
Julia L. George, RN, MSN, FRE
Editor
David Kalbacker
Photography
DayMeetsNight Media Services
Mission Statement
The mission of the North
Carolina Board of Nursing is to
protect the public by regulating the
practice of nursing.
Advertisements contained herein
are not necessarily endorsed by the
North Carolina Board of Nursing.
The publisher reserves the right to
accept or reject advertisements for
the Nursing Bulletin.
All art (photos, paintings, draw-ings,
etc.) contained in this pub-lication
is used under contractual
agreement.
145,000 copies of this document
were printed and mailed for a cost of
$0.12 per copy.
The North Carolina Board of
Nursing is an equal opportunity
employer.
VOLUME 10 { NO 1} EDITION 28
Table of Contents
8 Election Results for 2013
NC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Social Networking and Nurses
Chastain recipient of Employee
Excellence Award
22
Attention: Are You Interested in an
Out-of-State Nursing Program?
18
14 CE Opportunities for 2013
Calling All RNs, LPNs, Nursing
Managers, and Nursing Faculty!
Opportunities Available for YOU!
8
Bulletin Nursing
pcipublishing.com
Created by Publishing Concepts, Inc.
David Brown, President • dbrown@pcipublishing.com
For Advertising info contact
Victor Horne • 800.561.4686 ext 114
vhorne@pcipublishing.com
ThinkNurse.com
DEPARTMENTS:
4 From the Executive Director
6 From the Board Chair
19 Summary of Actions
30 Classifieds
24 Prescription data reported to CSRS
15 Decision Tree for Delegation for UAP
28 The Art of Nursing & the Computer.”
4 Bulletin { Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . .
Nursing
Official Publication Nursing from the
Executive Director
Up to Full
strength and
moving forward
NC
As we move into the last quarter of 2013 I am
happy to report several recent accomplishments
here at the Board.
The Board is once again back to its
full compliment of 14 members with the
appointment of Pat Campbell, RN. Her
appointment came at the end of the legislative
session. She was appointed by the Speaker-of-
the House of the General Assembly. Also,
relating to Board members, congratulations to
Robert Newsom, LPN on his re-election to the
Board for a second term. Congratulations as
well to Deborah Herring, RN who was elected
from among a field of 10 candidates for the RN-At-
Large seat on the Board. Ms. Herring, who
will join the Board in January, is the Director of
Nursing at the Pitt County Health Department,
in Greenville.
Board members and staff have worked
diligently on the development the Board’s
proposed Strategic Plan for 2014-2017. In the
coming weeks this plan will be posted to the
Board’s website.
And speaking of websites …. We hope you
like our updated version. Additional updates
and changes are still being made but our overall
goal was to make it easier for licensees and the
general public to find the information they need.
A new on-line licensure system has also
recently been launched that provides enhanced
security and functionality to all licensees.
A recent review of the number of North
Carolina nurses taking advantage of our featured
CE stories is very encouraging. Thousands of
nurses have read these important articles and
this issue of the Bulletin contains a CE article on
utilizing social networking. Author and Board
staff member Crystal Tillman Harris, RN, DNP
gives readers several compelling do’s and don’ts
( P. 10)
Last, but truly not least, there are some
recent staff accomplishments noted in this
issue. They include: Kathy Chastain’s, RN,MN,
FRE receipt of the 2013 NCBON Employee
Excellence Award (P. 22) and Kathleen
Privette’s, RN,MSN,FRE completion of the
Institute of Regulatory Excellence Fellowship
progam ( P. 22)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
As a licensed nurse in North Carolina, you have
the opportunity to elect nursing members each
year who are charged by the General Assembly
to ensure minimum standards of competency and
provide the public safe care. In addition, the Board
has the responsibility to review its own composition,
leadership and terms of office to ensure Board
positions and member qualifications align with the
health care environment in order to make informed
decisions regarding regulation.
In September 2012, the Board appointed an Ad
Hoc Committee charged with gathering meaningful
data to make an informed decision regarding Board
composition, leadership and terms. Please take a
few moments to complete the Board Composition
and Tenure survey located on the home page of the
Board’s website (www.ncbon.com).
If you would like more information regarding the
functions and responsibilities of the Board prior to
completion of the survey, you can visit our website
at http://www.ncbon.com/dcp/i/board-information-historical-
information.
Thank you in advance for providing your valuable
feedback!
Your Board!
Your Voice!
NC
6 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The North Carolina Board of Nursing began
2013 celebrating 110 years of excellence in nursing
regulation. We are still celebrating! In 1902 the
visionary work of Mary Lewis Wyche was put
into action. “Through her untiring efforts a law
for compulsory registration of graduate nurses
was passed in 1903. North Carolina was the first
state in the Union to get this law passed” (Wyche
& Heinzerling, 1938, p. x). With this vision came
change and today NCBON continues to be at the
forefront of nursing regulation in its mission to protect
the public by regulating the practice of nursing.
An example of how North Carolina continues to
influence and facilitate change at the national level
was noted of the September meeting at the National
Council State Boards of Nursing orientation for new
committee Chairs. In order to be selected as a
chair, one has to make application and be selected.
The NCSBON has 12 committees appointed for
2014 and North Carolina has four Board Members
and staff serving as Chairs: Dr. Bobby Lowery chairs
the Distance Learning Education Committee; Julie
George, Executive Director, chairs the Finance
Committee; Dr. Linda Burhans, Associate Executive
Director, chairs the Institute of Regulatory Excellence;
and I have the privilege to chair the Leadership
Academy Committee. Your Board and Board staff
are hard at work making a difference in nursing.
Embracing change and looking to the next three
years, the Board has approved a new strategic plan
for 2014-2017. This plan calls for the Board to focus
on two areas with five initiatives.
I. Enhance Public protection through the Board’s
proactive leadership by:
• Maintaining resources and flexibility to support the
Board’s mission without the use of public funds
• Ensuring equitable, efficient and effective
regulatory processes
• Collaborating with external stakeholders to
address impacts of Affordable Care Act
II. Advance best practices in nursing regulation by
• Implementing evidence-based decision-making to
improve outcomes
• Facilitating innovations in Education and Practice
The timing of the new strategic plan is spot on.
The Affordable Care Act is here and with this new
law comes changes that will affect everyone. On
September 26, 2013 Vice President Joe Biden along
with Health and Human Services Secretary Kathleen
Sebelius held a conference call with nurses across
the US. I joined in this call along with some 3,000
nurses from more than 25 nursing organizations. Vice
President Biden personally thanked nurses across the
country for our work as the country moves to this
change in health care.
Change is in the air!
Dr. Peggy Walters, RN
Chair
Wyche, M.L., & Heinzerling, E.L. (Eds.). (1938). The
history of nursing in north Carolina. Chapel Hill: The
University of North Carolina Press.
http://campaignforaction.org/community-post/
conference-call-vice-president-joe-biden-and-health-and-
human-services-secretary
from the Board Chair
Change is in the Air!
NC
Mary
Lewis
Wyche
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Bulletin Nursing
{ Official Publication of the No r t h Ca r o l i n a Board of Nursing } . . . . . . . . . . . . . . . . . . ELECTION RESULTS FOR 2013
Deborah Herring, Director of Nursing at the Pitt County Health
Department in Greenville, NC was elected as an RN-At-Large to the
NC Board of Nursing. Ms. Herring has more than 37 years of nursing
experience, 29 years of that in the public health field.
Robert Newsom, an LPN with more than 15 years of experience
nursing, was re-elected to the Board to serve a second 4-year term.
North Carolina is the only state in the nation where licensed nurses
elect the majority of their Board. Elections are held every year for specific
slots on the Board. Should you have an interest in running, or know
someone who might, be sure to read the Nomination Form on page 9.
Chair and Vice-Chair elected.
Dr. Peggy Walters, RN was re-elected to Chair the Board for 2014 and
public member, Martha A. Harrell was elected as Vice-Chair for 2014.
New Public Member
Pat Campbell, an experienced nurse, was named to the Board by
N.C. General Assembly Speaker Thom Tillis. Campbell will take the slot
vacated by James Forte who resigned in the Spring.
Results
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Nomination of Candidate for Membership on the North Carolina Board of Nursing for 2014
We, the undersigned currently licensed nurses, do hereby petition for the name of , RN
/ LPN (circle one), whose Certificated Number is , to be placed in nomination as a Member of
the N.C. Board of Nursing in the category of (check one):
o ADN/Diploma Nurse Educator o Staff Nurse o License Practical Nurse
Address of Nominee:
Telephone Number: (Home) (Work)
E-mail Address:
PETITIONER - (At least 10 petitioners per candidate required. Only RNs may petition for RN nominations).
To be postmarked on or before April 1, 2014
Name Signature Certificate Number
Please complete and return nomination forms to 2014 Board Election, North Carolina Board of Nursing, P.O. Box 2129, Raleigh, NC 27602-2129.
Nomination Form for 2014 Election
Although we just completed a succesful Board of Nursing election, we are already getting ready
for our next election. In 2014, the Board will have three openings; one ADN/Diploma Nurse
Educator, one Staff Nurse and one LPN. This form is for you to tear out and use. This nomina-tion
form must be completed on or before April 1, 2014. Read the nomination instructions and
make sure the candidate(s) meet all the requirements.
Instructions
Nominations for both RN and LPN positions shall be made by submitting a completed petition
signed by no fewer than 10 RNs (for an RN nominee) or 10 LPNs (for an LPN nominee) eligible
to vote in the election. The minimum requirements for an RN or an LPN to seek election to the
Board and to maintain membership on it are as follows:
1. Hold a current unencumbered license to practice in North Carolina
2. Be a resident of North Carolina
3. Have a minimum of five years experience in nursing
4. Have been engaged continuously in a position that meets the criteria for the specified Board
position, for at least three years immediately preceding the election.
Minimum ongoing-employment requirements for both RNs and LPNs shall include continu-ous
employment equal to or greater than 50% of a full-time position that meets the criteria for
the specified Board member position, except for the RN at-large position.
If you are interested in being a candidate for one of the positions, visit our website at www.
ncbon.com for additional information, including a Board Member Job Description and other
Board-related information. You also may contact Chandra, Administrative Coordinator, at
chandra@ncbon.com or (919) 782-3211, ext. 232. After careful review of the information
packet, you must complete the nomination form and submit it to the Board office by April 1,
2014.
Guidelines for Nomination
1. RNs can petition only for RN nominations and LPNs can petition only for LPN nominations.
2. Only petitions submitted on the nomination form will be considered. Photocopies or faxes
are not acceptable
3. The certificate number of the nominee and each petitioner must be listed on the form. (The
certificate number appears on the upper right-hand corner of the license.)
4. Names and certificate numbers (for each petitioner) must be legible and accurate.
5. Each petition shall be verified with the records of the Board to validate that each nominee
and petitioner holds appropriate North Carolina licensure.
6. If the license of the nominee is not current, the petition shall be declared invalid.
7. If the license of any petitioner listed on the nomination form is not current, and that
finding decreases the number of petitioners to fewer than ten, the petition shall be declared
invalid.
8. The envelope containing the petition must be postmarked on or before April 1, 2014, for the
nominee to be considered for candidacy. Petitions received before the April 1, 2014, deadline
will be processed on receipt.
9. Elections will be held between July 1 and August 15, 2014. Those elected will begin their
terms of office in January 2015.
Please complete and return nomination forms to 2014 Board Election, North Carolina Board of
Nursing, P.O. Box 2129, Raleigh NC 27602-2129.
Bulletin 10 Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . By Crystal Tillman Harris, DNP, RN, CPNP
The use of social media, including
Facebook, Twitter, LinkedIn, YouTube,
blogs, chat rooms, MySpace and other
similar sites are increasing exponentially.
A 2010 Pew report stated that among
adults, 73% use Facebook, and 14% use
LinkedIn (Pew Report, 2010). The use
of social media will continue to rise and
is a common daily occurrence for most
of us.
Nurses have an added responsibility
of ethical use related to personal use of
social networking. Once again this year,
nurses were ranked highest on honesty
and ethical standards according to the
Gallup poll, as being the most trusted
profession in the United States (Jones,
2011). Nurses have held the number
one spot every year since 1999, with
the exception of 2001 when firefighters
topped the list following the September
11 attacks. As nurses, it is important to
uphold the public’s trust and respect in
all areas of our lives, including the use
of social networking. Therefore, as the
most trusted healthcare professionals,
nurses should not only understand the
use of these technologies, but nurses
should also consider when or where to
use these technologies.
Benefits of Social Networking
It is wonderful to live in an age of
social networking and see the benefits
provided to nurses. As nurses, we
educate our patients and can provide
appropriate websites for patient and
family education. Many nurses use it
as a means of professional networking
and communication with colleagues.
Networking can also disseminate
research and evidence-based practice
findings to colleagues. Smart phones
and tablets have entered the health
care arena and allow easy access of vital
information that can ensure effective
care of the patient. The benefits of
social networking are numerous, and will
increase in the future.
Concerns of Social Networking
With the increase in technology, also
come some concerns for the profession.
Inappropriate sharing of personal or
work information that reflects poorly
on the nurse and professionalism in
nursing is a concern for all of us. Many
times breaches of patient confidentiality
can occur, either intentionally or
inadvertently. Examples include
description of a patient with enough
detail for identification, posting videos
or pictures of patients, and referring
to the patient in a demeaning manner
(ANA, 2011). This can lead to a
breach of patient confidentiality and
privacy and damage to a nurse’s career.
Also of concern is the ability of the
nurse to become distracted while using
smart phones. Such distractions have
the potential to be catastrophic. There
are appropriate uses of technology at
work during patient care…and checking
one’s Facebook status is not one of
them!
Students have been expelled from
nursing school for posting online photos
of themselves with a placenta and nurses
have been fired for discussing patient
cases on Facebook. In the Brynes vs.
Johnson County Community College
litigation, a nursing student posted a
photo of herself with a placenta on her
personal Facebook page. The photo
went viral within hours; the student was
expelled one day later and was told that
she could re-apply to enter the program
the following year. The patient issue
was that in the photo you could see
the student’s ID badge and the school’s
patch on her uniform. By right-clicking
on the photo the embedded date of the
photo is retrievable. Since few babies
were delivered in that hospital that day,
it was easy to “track” and connect the
placenta to the patient. “The Privacy
Rule protects all individually identifiable
health information held or transmitted
by a covered entity or its business
associate, in any form or media, whether
electronic, paper or oral” (Hader, 2010).
Principles for Social
Networking
The National Council of State Boards
of Nursing (NCSBN) and the American
Nurses Association (ANA) have
mutually endorsed each organization’s
guidelines for upholding professional
boundaries in a social networking
environment and have created a joint
webinar on Guidelines for Social Media
(ANA and NCSBN, 2011). The
NCSBN White paper: A nurse’s guide
to the use of social media lists actions
nurses can take to minimize risk and
provides scenarios of unprofessional
behavior based on actual events reported
to Boards of Nursing (NCSBN, 2011).
The ANA publication, Principles
for Social Networking and the Nurse:
Objective
The purpose of this article is to
provide information about social
networking as related to nursing
practice, and enhance the nurse’s
knowledge and application of social
networking
Highlights The use of social
networking can have numerous
benefits but also unintended
consequences for an individual
nurse’s career. Remember that
standards of professionalism are
the same online as in any other
circumstance.
Social Networking and Nurses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Guidance for the Registered Nurse,
is based on the ANA foundational
documents on ethics and standards
of practice (ANA, 2011). A Social
Networking Principles Toolkit consisting
of a fact sheet, tip-card, and poster
is available at no cost on the ANA
website: http://nursingworld.org/
socialnetworkingtoolkit
The American Nurses’ Association
(ANA) has developed a guideline for use
of social media by nurses that includes
principles for social networking that can
lead to appropriate use of the technology
(ANA, 2011). Simply removing a
name or face does not necessarily protect
the patient’s identification. The
principles are:
• Nurses must not transmit or place
online individually identifiable
patient information.
• Nurses must observe ethically
prescribed professional patient-nurse
boundaries.
• Nurses should understand that
patients, colleagues, institutions,
and employers may view postings.
• Nurses should take advantage
of privacy settings and seek to
separate personal and professional
information online.
Nurses should bring content that
could harm a patient’s privacy,
rights, or welfare to the attention
of appropriate authorities. Nurses
should participate in developing
institutional policies governing online
conduct.
The Health Insurance Portability
and Accountability Act (HIPAA)
protection includes information that
can reasonably be used to identify the
patient.
HIPAA’s Dos and Don’ts of Social
Networking:
• Do make a distinction between
your personal life and professional
life online.
• Do use social media for
educational and professional
purposes.
• Do be mindful of HIPAA.
• Do set your privacy settings as high as
possible.
• Don’t be lulled by false security.
• Don’t discuss your patients or your
colleagues.
The Code of Ethics for Nurses provides a
framework for nurses in ethical decision-making
and can provide guidance in the
use of social media (ANA, 2001). The
Code of Ethics for Nurses reminds us of
our primary commitment to patients, to
practice with compassion and respect for
all individuals, and the requirement to
disseminate knowledge (ANA, 2001).
According to the ANA:
The patient’s well-being could be
jeopardized and the fundamental trust
between patient and nurse be destroyed
by unnecessary access to data or by the
inappropriate disclosure of identifiable
patient information. The rights, well-being,
and safety of the individual patient
should be the primary factors in arriving
at any professional judgment concerning
the disposition of confidential information
received from or about the patient,
whether oral, written, or electronic.
NC
continued on page 12 >>>
12 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Consequences for Inappropriate
Use of Social Networking
There are consequences to
inappropriate use of social media. The
potential consequences vary according
to the specific breach of trust. The
incident may be reportable to the North
Carolina Board of Nursing (NCBON).
The NCBON may investigate the nurse
after a report of inappropriate use of
social media on the grounds of (NCSBN,
2011):
• Unprofessional conduct
• Unethical conduct
• Moral turpitude (a evil quality of
behaving)
• Management of patient records
• Revealing a privileged
communication: and;
• Breach of confidentiality
If the NCBON finds the allegations
to be true, the nurse can face disciplinary
action ranging from a reprimand or
sanctions to temporary loss of license.
Thirty-three state BONs reported
complaints last year against nurses who
violated patient privacy using social
media (NCSBN, 2011). In many
cases, the nurse inadvertently breached
confidentiality.
There may be other consequences
also. The nurse may face complaints that
a state or federal law to protect patient
confidentiality was breached. This
violation can result in civil or criminal
charges. There is also the possibility
the nurse could face a lawsuit for
personal damages including defamation
or invasion of privacy. If employment
rules were broken, the nurse may face
suspension or termination at work.
The line between speech protected
by labor laws and the First Amendment
and the ability of an employer to
impose expectations on employees
outside of work is still being determined
(National Labor Relations Board, 2011).
Nonetheless, inappropriate comments
can be detrimental to a cohesive health
care delivery team and may result in
sanctions against the nurse (Cronquist
and Spector, 2011).
Policies
Organizations are finding the need
to develop policies and professional
guidelines to aid nurses in negotiating
responsibly and professionally the use of
social networking. This is beginning to
happen in some medical institutions but
needs more widespread attention in order
to avoid legal and ethical problems.
Managers need to be aware that,
although sending a friend request to
an employee might seem rather fun
and friendly, it could have unintended
consequences. Even if the manager is
comfortable initiating the request, the
employee may not feel the same way,
creating a potentially negative undertone
to their working relationship. It may
lead to potential claims of fraternization,
harassment, or stalking.
Inappropriate social networking should
also be included in nursing education
program curriculums. Discussions of
professional conduct and ethical behavior
in the health care workplace and clinical
settings are necessary. The importance of
social networking must be a priority with
new students during orientation, and the
potential pitfalls social media may create
for nurses.
Most health care employers expect
that the employee will follow the same
behaviors online as they would in face-to-
face contact. Be sure to know the
policies of your employer or academic
institution. Many institutions now have
policies such as:
• Do not “friend” patients
• Do not accept “friend requests” from
patients or their family members
• Never share any patient information
via Facebook or other social media
• Never post pictures of patients or pose
with patients for pictures.
• Never give medical advice via social
media.
Summary
Our online conversation should reflect
the same professionalism that is expected
when working with the public. If you
are about to post an item that you
know would be embarrassing if seen
by a colleague, employer, patient, or
family member, then do not post it. It
is essential to maintain professional
integrity when incorporating networking,
even when doing so only in your personal
life.
Remember once you post something,
there is a digital footprint forever. Just
because you delete a post, photo or video,
does not mean it is destroyed. Data can
be retrievable from law enforcement or
technology experts.
The golden rule in social networking
is this: assume that there is no privacy.
Pretend that what you are writing is
appearing on a permanent billboard. If
you would not want it to be printed for
all to see, then think twice before posting
to a social media site.
Examples of Inappropriate Posts from
Ethical Reasoning and Online Social
Media:
My patient was the cutest little 70-year-old
lady. And I found out she lives in my
neighborhood. Awesome…a new friend.
So far, my clinical sucks…when will I
start doing the fun stuff?
First day off orientation, and I feel
completely overwhelmed! I seriously
don’t know what I’m doing yet. I feel
sorry if you were my patient today…but I
will get better.
The new staffing policy here is awful…
who thought it was OK to have each
nurse have 6 patients. Looks like our
NAs will have to do a lot more!
Friday afternoon….so glad the weekend
is here. Time to get drunk. I need a
vacation from responsibility.
What’s up everyone? I’m on a break
at clinical and had some time to post.
Anybody out there have a minute to
catch up?
I’m going to make sure that I have a
living will. I just don’t understand why
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
the patient I cared for today wants
“everything done” to hang on.
My supervisor was bugging me today
to join ANA. Why would I need to
do that?
(Englund et al., 2012)
References
American Nurses’ Association.
ANA’s Principles for Social
Networking and the Nurse. Silver
Spring, MD, ANA, 2011.
American Nurses’ Association.
Code of Ethics for Nurses
with Interpretive Statements.
Available at: http://nursingworld.
org/MainMenuCategories/
EthicsStandards/
CodeofEthicsforNurses/Code-of-
Ethics.aspx. Accessed July 22, 2013.
American Nurses Association.
Guidelines for using social media.
In: ANA: The American Nurse.
November/December 2011:14.
American Nurses Association and
National Council of State Boards of
Nursing. (2011). ANA and NCSBN
unite to provide guidelines on social
media and networking for nurses.
Available at:
http://www.nursingworld.org/
FunctionalMenuCategories/
MediaResources/PressReleases/2011-
PR/ANA-NCSBN-Guidelines-
Social-Media-Networking-for-Nurses.
aspx. Accessed July 22, 2013.
Bynes vs. JCCCC – Transcript of
the Ruling of the Court, January 24,
2011. Retrieved July 22, 2013 from
www.redstate.com
Cronquist, R., & Spector, N. (2011).
Nurses and Social Media: Regulatory
Concerns and Guidelines. Journal of
Nursing Regulation, Vol 2(3) 37-40.
Englund, H., Chappy, S.,
Jambunathan, J., & Gohdes, E.
(2012). Ethical Reasoning and
Online Social Media. Nurse
Educator, Vol 37(6). 242-247.
Hader, A. & Brown, E. (2010).
Patient privacy and social media.
AANA Journal, 78, 270-274.
Jones, J. Record 64% Rate Honesty,
Ethics of Members of Congress Low:
Ratings of nurses, pharmacists, and
medical doctors most positive. Dec.
12, 2011.
National Council of State Boards of
Nursing. White Paper: A Nurse’s
Guide to the Use of Social Media.
August 2011. Available at: https://
www.ncsbn.org/Social_Media.pdf.
Accessed July 22, 2013.
CAUTION: YouTube and
Competency
Some YouTube videos may be an
excellent educational resource when
a licensed nurse is learning a new
procedure. Since there is a plethora
of videos on YouTube you should use
caution when selecting educational
videos. As you look to see the
expertise of an author when reading
a professional document or article,
so too you should do the same with
YouTube. Always assure the video
content was provided or approved by
a reputable nursing/medical authority.
As well, watching a YouTube
video does not satisfy the
requirements of nursing competency.
Watching a video can be part of a
learning plan, but should never be
an RN’s only resource. The nurse
should also review nursing literature
for knowledge in pathophysiology
and expected and adverse outcomes.
In addition, the nurse should always
be observed completing an activity by
a competent RN or other authorized
licensed healthcare provider to assure
competency.
NC
EARN CE CREDIT
INSTRUCTIONS
Read the article and on-line reference
documents (if applicable). There is not a test
requirement, although reading for comprehension
and self-assessment of knowledge is encouraged.
RECEIVE CONTACT HOUR CERTIFICATE
Go to www.ncbon.com and select “Events,
Workshops & Conferences”; then select “Board
Sponsored Workshops”; under “Bulletin Articles,”
scroll down to the link “Social Networking and
Nurses.” Register, complete and submit the
evaluation, and print your certificate immediately.
Registration deadline is October 1,
2015.
PROVIDER ACCREDITATION
The North Carolina Board of Nursing will
award 1.0 contact hours for this continuing
nursing education activity.
The North Carolina Board of Nursing is
an Approved Provider of continuing nursing
education by the North Carolina Nurses
Association, an accredited approver by the
American Nurses Credentialing Center’s
Commission on Accreditation.
NCBON CNE Contact Hour Activity
Disclosure Statement
The following disclosure applies to the
NCBON continuing nursing education article
entitled “Social Networking and Nurses”:
Participants must read the CE article and
online reference documents (if applicable)
in order to be awarded CNE contact hours.
Verification of participation will be noted by
online registration. No financial relationships
or commercial support have been disclosed by
planners or writers which would influence the
planning of educational objectives and content
of the article. There is no endorsement of any
product by NCNA or ANCC associated with the
article. No article information relates to products
governed by the Food and Drug Administration.
14 Bulletin Nursing
{ Official Publication of the No r t h Ca r o l i n a Board of Nursing } . . . . . . . . . . . . . . . . . . Nurses are key players in leading and designing safe
healthcare delivery systems. As healthcare delivery systems
evolve to provide more cost-effective models of care, the
nurse’s delegation of tasks and activities to unlicensed assistive
personnel (UAP) is anticipated to increase. As the need
for delegation to a variety of UAP escalates, the registered
nurse (RN) and licensed practical nurse (LPN) must continue
to develop and utilize efficient, effective decision-making
knowledge and critical thinking skills to ensure the delivery of
safe client care.
In January, 2013, the Board of Nursing’s (NCBON)
Education and Practice Committee was charged “To review
Registered Nurse (RN) and Licensed Practical Nurse (LPN)
delegation of nursing activities to Unlicensed Assistive
Personnel (UAP), including medication administration,
across diverse healthcare settings to proactively promote safe,
effective care, maximizing the capabilities of licensed nurses
and unlicensed care providers.” In moving forward with the
charge, the Education and Practice Committee developed a
new version of the NCBON Decision Tree for Delegation to
UAP. This new version was approved by the Board of Nursing
on September 20, 2013 for immediate implementation by all
RNs and LPNs in all practice settings across the state.
The purpose of the NCBON Decision Tree for Delegation
to UAP is to support nurses in making appropriate decisions
when delegating nursing tasks or activities to UAP. The
Nursing Practice Act (NPA) and Administrative Code
(Rules) define delegation as a component of the scope of
practice for both the RN and LPN, and specify the criteria
that must be in place for appropriate nursing delegation to
UAP. Delegation requires nursing judgment and decision-making
based on four essential steps as detailed in the new
version of the NCBON Decision Tree for Delegation to
UAP: Assessment and Implementation; Communication;
Supervision and Monitoring; and Evaluation and Feedback.
Effective nursing delegation of tasks/activities to UAP
depends upon the nurse’s abilities and skills to make
appropriate delegation decisions. Delegation is a client and
situation specific activity in which the nurse, RN or LPN,
must consider all the components of the delegation process
for each delegation decision. All nurses are encouraged to
review and use the NCBON Decision Tree for Delegation
to UAP as a framework to promote effective delegation and
ensure quality care is delivered. Delegation is a skill developed
through education and practice. The Board of Nursing
encourages nursing employers, directors, and managers to
establish delegation resources that are easily accessible to all
nurses. Effective delegation supports the NCBON mission to
protect the public by regulating the practice of nursing.
The new version of the NCBON Decision Tree for
Delegation to UAP is located on the Board of Nursing website
at www.ncbon.com, under the “Nursing Practice” heading,
subheading “Position Statements and Decision Trees”, and
“Decision Tree for Delegation to UAP.”
New Delegation Decision
Tree for Nurses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Is the task within the scope of practice for a licensed nurse (RN/LPN)? No Stop! Do not delegate to UAP.
Yes
Is RN assessment of client’s nursing care needs complete? Stop! RN to complete assessment, then proceed
with consideration of delegation.
Is the RN/LPN competent to make delegation decisions? Nurse is accountable for the decision to delegate, to
implement the steps of the delegation process, and to assure that the delegated task is appropriate based on
individualized needs of each client which includes stability, absence of risk of complications, and predictability
of change in condition. The delegating nurse must be competent to perform the activity. See (A) and (B) pg. 2
Stop! Do not
delegate to UAP.
Is the task consistent with the rules for delegation to UAP? Must meet all the following criteria:
􀂃􈍆 Frequently recurs in the daily care of a client or group of clients
􀂃􈍉 Is performed according to an established sequence of steps
􀂃􈍉 Involves little to no modification from one client care situation to another
􀂃􈍍 May be performed with a predictable outcome
􀂃􈍄 Does not inherently involve ongoing assessment, interpretation, or decision making which cannot be
logically separated from the procedure(s) itself; and
􀂃􈍄 Does not endanger the client’s life or well being.
Stop! Do not
delegate to UAP.
Stop! Do not proceed without evaluation of need for
policy, procedures and/or protocol or determination that it
is in the best interest of the client to proceed with
delegation in urgent or emergency situations.
Is appropriate supervision available? See (C) (D) (E) pg. 3 Stop! Do not delegate to UAP.
No
Yes
No
Yes
No
Yes
Are there written agency policies, procedures, and/or protocols in
place for this task?
No
No
Yes
Yes
No Stop! Do not delegate to UAP.
Yes
No
Does the capability of UAP match the care needs of the client?
See (A) and (B) pg. 2 No
Step 1 of 4: Assessment and Implementation
The UAP is responsible for accepting the delegation, seeking clarification of and affirming expectations,
performing the task correctly and timely communicating results to the nurse. Only the implementation of a
task/activity may be delegated. Assessment, planning, evaluation and nursing judgment cannot be delegated.
Delegation is a client and situation specific activity in which the nurse must consider all components of the
delegation process for each delegation decision. Specific direction by the nurse (RN, LPN) to UAP when
assisting the nurse with a task or nursing activity and under the direct visual supervision of the nurse is not
considered delegation.
Yes
Is the UAP properly trained and validated as competent by an RN
to accept the delegation?
Stop! Do not delegate until evidence of education
and validation of competency available, and then
reconsider delegation; otherwise do not delegate.
Proceed with delegation.
P.O. BOX 2129
Raleigh, NC 27602
DECISION TREE FOR DELEGATION TO UAP (919) 782-3211
FAX (919) 781-9461
Nurse Aide II Registry (919) 782-7499
www.ncbon.com
Is the activity allowed by the Nursing Practice Act, Board
Rules, Statements, or by any other law, rule or policy?
Stop! Do not delegate until the nurse has evaluated
capability of UAP matches the care needs of the
client.
Page 1 of 3
16 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
IMPORTANT COMPONENTS FOR DELEGATION TO UAP
Prior to proceeding to Step 2, consider the following:
Delegation is a process of decision-making, critical thinking and nursing judgment. Decisions to delegate nursing tasks/activities to UAP are based on the RN’s
assessment of the client’s nursing care needs. The LPN may delegate nursing tasks/activities to UAP under the supervision of the RN. Additional criteria that
must be considered when determining appropriate delegation of tasks include, but are not limited to:
(A) Variables:
􀂃􈍋 Knowledge and skill of UAP
􀂃􈍖 Verification of clinical competence of UAP
􀂃􈍓 Stability of the client’s condition which involves predictability, absence of
risk of complication, and rate of change
􀂃􈍖 Variables specific for each practice setting:
o The complexity and frequency of nursing care needed by a
given client population
o The proximity of clients to staff
o The number and qualifications of staff
o The accessible resources
􀂃􈍅 Established policies, procedures, practices, and channels of communication
which lend support to the types of nursing activities being delegated, or not
delegated, to UAP
(B) Use of critical thinking and professional judgment for The Five Rights of
Delegation:
1. Right Task – the task must meet all of the delegation criteria
2. Right Circumstance – delegation must be appropriate to the client
population and practice setting
3. Right Person – the nurse must be competent to perform the activity
and to make delegation decisions, the nurse must ensure the right
task is being delegated to the right person (UAP) and competence
has been validated by an RN, and the delegation is for the
individualized needs of the client
4. Right Communication – the nurse must provide clear, concise
instructions for performing the task
5. Right Supervision – the nurse must provide appropriate
supervision/monitoring, evaluation, and feedback of UAP
performance of the task
Step 2 of 4: Communication - Communication must be a two-way process
The nurse:
􀂃􈍁 Assesses the UAP’s understanding of:
o Task to be performed and expectations of performance of tasks
o Information to report including client specific observations, expected
and concerns
o When and how to report/record information
􀂃􈍃 Communicates Individualized needs of client population, practice
setting, and unique client requirements
􀂃􈍃 Communicates and provides guidance, coaching, and support for UAP
􀂃􈍁 Allows UAP opportunity for questions and clarification
􀂃􈍁 Assures accountability by verifying UAP accepts delegation
􀂃􈍄 Develops and communicates plan of action in emergency situations
􀂃􈍄 Determines Communication method between nurse and UAP
The UAP:
􀂃􈍁 Asks questions and seeks clarification
􀂃􈍉 Informs the nurse if UAP has not performed the
task or has performed it infrequently
􀂃􈍒 Requests additional training or guidance as
needed
􀂃􈍁 Affirms understanding and acceptance of
delegation
􀂃􈍃 Complies with communication method between
nurse and UAP
􀂃􈍒 Reports care results to nurse in a timely manner
􀂃􈍃 Complies with emergency action plans
Documentation by nurse and
UAP
(as determined by facility/agency
policy) is:
Timely, complete and accurate
documentation of provided care:
􀂃􈍆 Facilitates communication with
other members of the health care
team
􀂃􈍒 Records the nursing care
provided.
Page 2 of 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Step 3 of 4: Supervision and Monitoring – The RN supervises the delegation by monitoring the performance of the task and assures
compliance with standards of practice, policies and procedures. The LPN supervision is limited to on-the-job assurance that tasks have
been performed as delegated and according to standards of practice established in agency policies and procedures. Frequency, level,
and nature of monitoring vary with the needs of the client and experience of the UAP.
(C) The nurse takes into consideration the:
􀂃􈍃 Client’s health stability, status, and acuity
􀂃􈍐 Predictability of client response to interventions
and risks posed
􀂃􈍐 Practice setting and client population
􀂃􈍁 Available resources
􀂃􈍃 Complexity & frequency of nursing care needed
􀂃􈍐 Proximity of clients to staff
􀂃􈍎 Number and qualification of staff
􀂃􈍐 Policies, procedures, & channels of
communication established
(D) The nurse determines:
􀂃􈍔 The amount/degree of supervision required
􀂃􈍔 Type of supervision: direct or indirect
􀂃􈍔 The Five Rights of Delegation have been
implemented:
1. Right Task
2. Right Circumstances
3. Right Person
4. Right Directions and Communications
5. Right Supervision and Evaluation
(E) The nurse:
􀂃􈍍 Maintains accountability for nursing tasks/activities
delegated and performed by UAP
􀂃􈍍 Monitors outcomes of delegated nursing care tasks
􀂃􈍉 Intervenes and follows-up on problems, incidents, and
concerns within an appropriate timeframe
􀂃􈍎 Nursing management and administration
responsibilities are beyond LPN scope of practice. To
assure client safety, the LPN may need authority to
alter delegation or temporarily suspend UAP per
agency policy until appropriate personnel action can be
determined by the supervising RN.
􀂃􈍏 Observes client response to nursing care and UAP’s
performance of care
􀂃􈍒 Recognizes subtle signs and symptoms with
appropriate intervention when client’s condition
changes
􀂃􈍒 Recognizes UAP’s difficulties in completing
delegation activities
Step 4 of 4: Evaluation and Feedback – Evaluate effectiveness of delegation and provide appropriate feedback
􀂃􈍅 Evaluate the nursing care outcomes:
o (RN) Evaluate the effectiveness of the nursing plan of care and modify as needed
o (LPN) Recognize the effectiveness of nursing interventions and propose modifications to plan of care for review by the RN
􀂃􈍅 Evaluate the effectiveness of delegation:
o Task performed correctly?
o Expected outcomes achieved?
o Communication was timely and effective?
o Identify challenges and what went well
o Identify problems and concerns that occurred and how they were addressed
􀂃􈍐 Provide feedback to UAP regarding performance of tasks/activities and acknowledge the UAP for accomplishing the task
References:
G.S. 90-171.20 (7)(d) & (i) and (8) (d) Nursing Practice Act American Nurses Association Decision Tree for Delegation by Registered Nurses, 2012
21 NCAC 36.0221 (b)Licensed Required Joint Statement on Delegation ANA and NCSBN Decision Tree for Delegation to Nursing
21 NCAC 36.0224 (a) (b) (c) (d) (e) (f) (i) & (j) Components of Practice for the Registered nurse Assistive Personnel, 2005
21 NCAC 36.0225 (b) (c) (d) (e) (f) Components of Practice for the Licensed Practical Nurse National Council of State Boards of Nursing Decision Tree – Delegation to Nursing Assistive
21 NCAC 36.0401 (c) Roles of Unlicensed Personnel Assistive Personnel, 2005
Page 3 of 3 Origin: 5/2000; Revised 4/2007; Reviewed 2/2013; Revised 9/2013
18 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The Board of Nursing receives many
questions from individuals who are
exploring nursing education originating
from out-of-state. If you are interested
in attending an out-of-state nursing
program, please read these FAQs.
Is the NCBON imposing restrictions
on out-of-state nursing education
programs? I am being told by an out-of-
state program that the NCBON is
preventing them from admitting NC
residents as students.
The NCBON is not imposing
restrictions on out-of state nursing
education programs. There is, however,
a law in NC which requires ANY out-of-
state program that conducts ANY
educational activities in NC (including
on-line programs, correspondence
courses, and student clinical experiences)
to be licensed by the University of
North Carolina (UNC) System General
Administration/Board of Governors.
This is required by a law not associated
with the NC Board of Nursing, but
rather with the UNC System. When
considering enrollment in ANY out-of-
state nursing program, individuals
should check with the UNC System
to verify licensure status by calling
919-962-4558 or on the UNC System
website at: http://www.northcarolina.
edu/aa planning/licensure/licensed.htm
Does the NCBON approve nursing
graduate-level (masters and doctoral)
out-of-state programs/online programs/
correspondence courses?
The NCBON does not approve
or disapprove graduate-level nursing
programs, in-state, nor out-of-state,
regardless of teaching methodologies
used. Programs over which the
NCBON does NOT have jurisdiction
include: RN-BSN, masters, and
doctoral programs. While some states
do have jurisdiction over programs
beyond those leading to initial
licensure, the NCBON does not. The
NCBON has jurisdiction only over pre-licensure
nursing programs located in
NC that prepare graduates to take the
initial LPN or RN licensure examination
If I attend a nursing education
program in another state, am I able
to complete my student clinical
experiences in NC?
a) Pre-licensure (RN or LPN)
students who are attending out-of-
state programs and wish to
complete clinical experiences in
North Carolina must contact the
NCBON by email at education@
ncbon.com to obtain information
regarding requirements.
b) Graduate (master’s or doctoral)
students who do not hold a NC
or multistate nursing license
must contact the NCBON by
email at practice@ncbon.com
to obtain information regarding
requirements for the completion
of clinical experiences in NC.
c) Graduate (master’s or doctoral)
students who hold a NC or
multistate nursing license may
seek clinical experiences in NC
without NCBON notification or
approval.
(NOTE: The UNC System requires
that all out-of-state degree granting
institutions be licensed as described in
the above question. Although not an
NCBON requirement, all students are
urged to ascertain their institution’s NC
licensure status.)
ERQUAEIMRttentionN: T A rves Y.o EFOPRu InteresSteSdIO inN aAILn SM
Out-of-State Nursing Program?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Administrative Maters
• Approved revisions to Vision and Values
Statements as follows:
Vision: The NCBON excels in advancing public
protection in a dynamic healthcare environment.
Values: Setting the PACE for Public Protection
and Regulatory Excellence
Professionalism
Accountability
Commitment
Equity/Fairness
• Approved 2014 – 2017 Strategic Plan
Strategic Initiative #1: Enhance public protection
through the Board’s proactive leadership by
a. Maintaining resources and flexibility to sup-port
the Board’s mission without the use of
public funds
b. Ensuring equitable, efficient and effective
regulatory processes
c. Collaborating with external stakeholders
to address impacts of Health Care Reform
Strategic Initiative #2: Advance best practices
in nursing regulation by
a. Implementing evidence-based decision-making
to improve outcomes
b. Facilitating innovations in Education and
Practice
Investigation and Monitoring
Actions
Received reports and Granted Absolutions to 3
RNs and 1 LPN
Removed probation from the license of 19 RNs
and 4 LPNs
Accepted the Voluntary Surrender from 12 RNs
and 2 LPNs
Suspended the license of 13 RNs and 4 LPNs
Reinstated the license of 16 RNs and 2 LPN
Number of Participants in the Alternative
Program for Chemical Dependency: 158 RNs
and 8 LPNs (Total = 166)
Number of Participants in the Chemical
Dependency Program (CDDP): 87 RNs, 8 LPNs
(Total = 95)
Number of Participants in Illicit Drug and Alcohol/
Intervention Program: 25 RNs, 10 LPNs. (Total
= 35)
Education maters:
Ratification of Full Approval Status – 10 programs
Determination of Program Approval Status – 1
program
Ratification of Program Expansion – 1 program
ACEN/CCNE Accreditation Decisions – 9 pro-grams
SUMMARY of
Activities
20 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Calling All RNs, LPNs, Nursing
Managers, and Nursing Faculty!
Opportunities Available for YOU!
The National Council of State Boards
of Nursing (NCSBN) wants YOU
to participate in the development of
the NCLEX-RN® and NCLEX-PN®
examinations. The Item Development
Program is a key component in
maintaining high quality NCLEX®
items.
NCSBN depends on practicing
nurses to assist in the NCLEX® item
development process. Nurses may
be selected to be item writers or item
reviewers. If you are selected to serve as a
member, you will:
• Contribute to continued excellence
in the nursing profession;
• Have opportunities to network on a
national and international level;
• Build new skills that are useful in
your current position, as well as for
professional growth; and
• Earn continuing education contact
hours.
Item writers create the questions
that are administered in the NCLEX®
examinations. You must be responsible
for teaching basic/undergraduate students
in the clinical area and must have a
master’s degree or higher (for the RN
exam only). Item reviewers examine the
items that are created by item writers.
You must have at least 2 years experience
and be currently employed in clinical
nursing practice AND working directly
with nurses who have entered nursing
practice during the past 12 months,
specifically in a precepting or supervising
capacity.
More information and an application
are available on NCSBN’s website
at www.ncsbn.org/1227.htm . If all
qualifications are met, NCSBN will
obtain approval from the NCBON.
Applications remain active for a two-year
period from the date of initial submission.
NCSBN will notify you when you are
considered for a specific panel in which
you will participate for three to five
days. Sessions are held throughout the
year in Chicago and your travel expense,
including lodging and meals, will be
covered.
If you prefer, you can send an e-mail
with your complete contact information
and listing your current employer
and supervisor to Burnette Brown at
bbrown@ncbon.com . The NCBON
will maintain your contact information
and inform you when NCSBN is seeking
applicants for specific panels.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Face-to-face workshop with Board of Nursing
consultants
If you are a chief nurse administrator or mid-level
nurse manager who would like to learn
about the functions of the Board of Nursing
and how these functions impact your role in all
types of nursing service settings, please consider
registering online for one of the following 2014
orientation sessions.
Go to: www.ncbon.com – Nursing Education -
Continuing Education – Board Sponsored
Offerings.
Scroll down the page until you see “On-Site
Workshop.”
Register for one of the following dates ($40
fee).
February 12, 2014 - Wednesday
April 9, 2014 - Wednesday
September 17, 2014 - Wednesday
November 6, 2014 - Thursday
All sessions are held at the North Carolina
Board of Nursing office in Raleigh, NC from 10
a.m. until 4 p.m.
If you attend the entire session, you will
be presented with 4.6 continuing nursing
education contact hours.
Participants must attend the entire session(s) in
order to earn contact hour credit. Verification
of participation will be noted by signature
on the roster. A completed evaluation form
must be returned. Planners and presenters
have declared that they have no conflict of
interest or financial relationships which would
influence the planning of this activity. If any
are discovered during the course of the activity,
an announcement will be made to inform the
participants. No commercial support, product
endorsements or products governed by the Food
and Drug Administration have been identified
for this activity.
The North Carolina Board of Nursing is an
approved provider of continuing nursing
education by the North Carolina Nurses
Association, an accredited approver by the
American Nurses Credentialing Center’s
Commission on Accreditation.
Orientation Sessions
for Administrators
of Nursing Services
and Mid-Level Nurse
Managers
22 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
The 2013 recipient of the Board of Nursing Employee Excel-lence
Award is Kathy Chastain, RN, MN,FRE, Associate Direc-tor
Regulation/Quality.
Chastain has demonstrated an outstanding commitment to
the growth and development of staff. Also, by serving as the
Quality expert to the Administrative Council, she has worked to
develop guidelines and measurement outcomes throughout the
organization.
As the supervisor of the Board’s investigative staff, Chastain
is a role model in the use of the “Just Culture” principles and has
lead the way to incorporate this philosophy into the culture of
Board staff. Based upon the outcomes of investigations --- under
Chastain’s leadership – the National Council of State Boards
of Nursing (NCSBN) have identified North Carolina as hav-ing
“best practices” in the core data submitted for review of all
member Boards. Chastain has participated in NCSBN meetings
to share her experience in implementing changes in our investi-gative
department under her leadership.
Recently, Chastain was interviewed by an investigative re-porter
from the Atlanta Journal Constitution regarding the cycle
times of case resolutions in North Carolina as compared to our
neighboring state to the South.
The Employee Excellence Award is especially meaningful, as
it recognizes the achievement of a Board Staff member who has
been nominated by their peers.
Please join the both the staff and the members of the North
Carolina Board of Nursing in congratulating Kathy Chastain as
the recipient of this year’s Employee Excellence Award.
Chastain recipient of Employee
Excelence Award
Kathleen Privette, RN,MSN, FRE Manager of Drug Moni-toring
Programs for the North Carolina Board of Nursing,
has completed The Institute of Regulatory Excellence (IRE)
Fellowship program sponsored by the National Council of
State Boards of Nursing (NCSBN). The four year professional
development program is designed for regulators to enhance
their knowledge of leadership in nursing regulation.
The program requires that each candidate complete a
project that contributes to the science of nursing regulation.
Privette’s research focused on attrition rates among nurses
enrolled in the Board’s Alternative Program for Chemical
Dependency.
The North Carolina Board of Nursing is proud to have 6 of
the 39 designated Fellows.
Privette completes Regulatory Fellowship
Licensure Review Panels
• Nov. 14, 2013
• Dec. 12, 2013
• Jan. 14, 2014
• Feb. 13, 2014
Administrative Hearing
• Dec. 13, 2013
• Feb. 6, 2014
Education/Practice
Comite
• Dec. 4, 2013
• Mar. 26,2014
Board Meting
• Jan. 23-24, 2014
North Carolina Board
of Nursing Calendar
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Online Bulletin
Articles
Webcasts
Social Networking and
Nurses
(1.0 CH)
No fee required
Delegation: What are
the Nurse’s
Responsibilities?
(2 CHs)
No fee required
Continuing Competence
Self Assessment: Have
You Met Your
Professional
Responsibility?
(1 CH)
No fee required
Competency Validation:
What Does it Mean for
You?
(.75 CH)
No fee required.
Public Protection
Through Safe Nurse
Staffing Practice
(.85 CH)
No fee required.
Incivility in Nursing
(1 CH)
No fee required.
Fitness for Duty
Includes Getting
Your ZZZZs
(1 CH)
No fee required.
Understanding the
Scope of Practice and
Role of the LPN (1 CH)
Provides information
clarifying the LPN scope
of practice. An important
course for RNs, LPNs,
and employers of LPNs.
No fee required.
LEGAL SCOPE OF
PRACTICE
(2.3 CHs)
Provides information
and clarification regarding
the legal scope of practice
parameters for licensed
nurses in
North Carolina.
$40.00 Fee.
Questions:
Pamela Trantham
919-782-3211 ext. 279
Pamela@ncbon.com
To access online CE articles, webcasts,
session registration, and the
presentation request form, go to:
www.ncbon.com Click on:
to the right of the homepage.
Questions on Online Bulletin Articles
Contact:: Linda Blain
919-782-3211 ext. 238 LindaB@ncbon.com
For Webcasts and Orientation Session see
bottom of columns for contact info.
Face-to-face workshop at
NC Board of Nursing
office.
Information session
regarding the functions of
the Board of Nursing and
how these functions
impact the roles of the
nurse administrator
and the mid-level nurse
manager in all types of
nursing services.
Session Dates
November 6, 2013
$40.00 fee (non-refundable
unless
session is canceled)
Register online at
www.ncbon.com.
Registration at least two
weeks in advance of a
scheduled session
is required.
Seating is limited. There
is usually a waiting list for
this workshop. If you are
unable to attend and do
not have a substitute to
go in your place, please
inform the NCBON so
someone on the waiting
list can attend.
PAPER REGISTRATION
REQUEST, CONTACT
PAULETTE HAMPTON
919-782-3211 EXT 244
Orientation Session
PRACTICE CONSULTANT AVAILABLE TO PRESENT AT YOUR FACILITY!
An NCBON practice consultant is available to provide educational presentations upon request from agencies or organizations.
To request a practice consultant to speak at your facility, please complete the Presentation Request Form online
and submit it per form instructions. The NCBON will contact you to arrange a presentation.
Standard presentations offered are as follows:
• Continuing Competence (1 CH) – 1 hour - Presentation is for all nurses with an active license in NC and is an overview of continuing
competency requirements.
• Legal Scope of Practice (2.0 CHs) – 2 hours – Defines and contrasts each scope, explains delegation and accountability of nurse with
unlicensed assistive personnel, and provides examples of exceeding scope. Also available as webcast.
• Understanding the Scope of Practice and Role of the LPN (1 CH) - 1 hour - Assists RNs, LPNs, and employers of nurses in
understanding the LPN scope of practice. Also available as webcast.
• Documentation and Medication Errors (1 CH) – 1 hour – Explains purpose, importance, and desirable characteristics of documentation;
describes relationship between nursing regulation and documentation; identifies practices to avoid and those that may violate NPA; and
identifies most common medication errors and contributing factors.
• Nursing Regulation in NC (1 CH) – 1 hour – Describes Board authority, composition, vision, function, activities, strategic initiatives, and
resources.
• Introduction to Just Culture and NCBON Complaint Evaluation Tool (1.5 CHs) – 1 hour and 30 minutes - Provides information about
Just Culture concepts, role of nursing regulation in practice errors, instructions in use of NCBON CET, consultation with NCBON about
practice errors, and mandatory reporting. Suggested for audience NOT familiar with Just Culture.
• Introduction to the NCBON Complaint Evaluation Tool (1 CH) – 1 hour - Provides brief information about Just Culture concepts and
instructions for use of the NC Board of Nursing’s Complaint Evaluation Tool, consultation with NCBON about practice errors, and
mandatory reporting. Suggested for audience already familiar with Just Culture.
The North Carolina Board of Nursing is an approved provider of continuing nursing education by the North Carolina Nurses
Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
24 Bulletin Nursing
The NC Department of Health and
Human Services implemented the
Controlled Substances Reporting System
(CSRS) six years ago to monitor outpa-tient
dispensing of prescription con-trolled
substances on a statewide basis.
The system is authorized by a 2005 state
law, which clearly states the CSRS’s
purpose: To “improve the State’s ability
to identify controlled substance abusers
or misusers and refer them for treat-ment,
and to identify and stop diversion
of prescription drugs in an efficient and
cost-effective manner that will not im-pede
the appropriate medical utilization
of licit controlled substances.”
The law requires all outpatient
dispensers of controlled substances
in North Carolina to regularly report
prescription data to the CSRS. Eligible
practitioners (medical practitioners must
hold either a valid DEA registration or a
valid pharmacist’s license to view data)
may register for access to the system,
for the purpose of viewing individual
patients’ prescription profiles.
Since the system went live in July
2007, more than 17,500 physicians,
physician assistants, nurse practitioners
and other prescribers have signed up to
access CSRS data, and that number is
growing every week.
Q & A
Under what circumstances might a
physician check a patient’s prescription
profile with the CSRS?
They should be doing it to provide
pharmaceutical or medical care for their
patient.
What information would a query to the
CSRS on a particular patient return?
It would indicate the date a prescrip-tion
was dispensed, the amount dis-pensed,
whether it was a refill or a new
prescription, the number of refills, the
pharmacy where it was dispensed and the
practitioner who wrote the prescription.
It will also indicate the patient’s name
and address.
How should physicians and other pre-scribers
be using this data?
To provide comprehensive medical
or pharmaceutical care for their patient.
If the data reveal that the patient may
be seeking large quantities of controlled
substances or seeking prescriptions from
multiple providers, then the practitioner
should discuss this with the patient and
offer help.
Are you aware of situations where
prescribers are using data obtained
through the system to “fire” a patient?
Yes, not only to fire a patient, but
to exclude. We’ve heard of a couple
of situations where a pain manage-ment
specialist decides that a patient is
doctor-shopping and, based on what he
sees in the CSRS, decides not to take
on that patient. That is not an appropri-ate
use of the system. We’ve also heard
of numerous cases where, based on the
data, physicians have dismissed an estab-lished
patient. I don’t mean to suggest
that they can’t or shouldn’t do that. But
there’s a right and a wrong way to do it.
It’s complicated. First, we’ve had several
instances where the data has been wrong
and the patient has been right and the
physician hasn’t believed the patient.
And potential harm may come to the
patient when a physician decides to ex-clude
them. The fact that they’ve been
labeled or branded as a doctor-shopper
follows them and then other physicians
decide not to take them on.
What would be a preferable response?
If a patient is starting to see different
doctors, the physician can establish an
agreement or contract with the patient
that he only sees one physician or that
he notify and get approval from his
physician to see another physician. If
that contract is violated, you don’t need
to throw the patient out. It may be an
opportunity to expand the care. Maybe
refer that patient to more specialized
care or to a substance abuse program,
that kind of thing. Would you dismiss
a cardiac patient for not following his
or her diet? You’re going to have some
patients who after trying to intervene
and refer them for care and documenting
Prescription data reported to CSRS
continued on page 26
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26 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
those efforts may still have to be dismiss
ed.
But it shouldn’t be the first action you
take.
Correct. You may be able to use the
data to take a different approach. For
example, an emergency room doctor who
checked on a patient may say, ‘I don’t
want to give this person an opiate. I’m go-ing
to give them something else because
they’ve gotten a lot of opiates.’ It can be
useful in deciding what kind of treatment
you’re going to provide.
What if a patient claims that the in-formation
the CSRS has on them is not
accurate?
Sit down and discuss it with the
patient. Either the doctor or the patient
can contact the NC CSRS Staff and we
can help sift through what is accurate and
what is inaccurate in the system. Don’t
just assume that it’s a doctor shopper and
because he has a substance use problem,
he’s lying. He might be, but he might not
be. We’ve had too many occasions where
either there’s been a mistaken identity
or the dispensing pharmacy has loaded
up the wrong DEA number so the wrong
prescriber is on there, or other things like
that. Give the patient the benefit of the
doubt, at least the first time. Then inform
the patient you are going to follow them
very closely.
Could you go over the protocols for
accessing the CSRS? Who is authorized,
within a medical practice, to access the
system?
The prescriber or dispenser. Only the
person with that log on, not their nurse,
not their office manager, not another
prescriber. Each practitioner in the office
has to have their own login.
Beginning in 2014 we will be allow-ing
delegate accounts where an already
approved user may delegate the task of
running queries to someone else in the
office. This delegate will apply online and
be given their own individual username
and password. Never share your username
and password with anyone.
There’s another practice I see doctors
doing that is unlawful, and that is calling
up the police. You can’t do that. You can-not
release this data to the police.
Is there anything else you’d like to
mention that you feel is important for
physicians and other prescribers to un-derstand
about the CSRS?
We would eventually like to see this
become a standard of care in prescribing
controlled substances. Our hope is that
checking the system becomes an accepted
part of practice. A physician would not be
doing his or her best if they didn’t check
the system. The other message is that this
needs to be seen as a tool. It’s one piece of
the puzzle just like an X-ray or a lab test
or anything else. And it should be used
in combination with all the other stuff.
Physicians should not be relying on it as
a standalone item when making patient
care decisions. We hope this tool can as-sist
a physician in providing appropriate
care for the patient, including a referral
for treatment if indicated.
Anything else?
If you’re using the system, tell your
patients you’re doing it. Don’t do it
behind the patient’s back. Also, to help
prescribers become more comfortable
with addressing issues with patients sug-gest
learning more about SBIRT, which
stands for Screening, Brief Intervention
and Referral for Treatment. This is now a
billable service. You can learn more about
SBIRT by visiting www.sbirtnc.org.
Sign up to use the system
Clinicians who want to check a pa-tient’s
controlled substances prescription
profile must register for access with the
NC Controlled Substances Reporting Sys-tem.
To qualify, you must be authorized to
prescribe or dispense controlled substanc-es
for the purpose of providing medical or
pharmaceutical care for patients.
How do I sign up for access?
Download and complete a short enroll-ment
application from the CSRS website.
Please note that the form must be nota-rized
and mailed with a copy of a photo
ID and signed copy of a privacy statement
to the CSRS. Approved applicants will be
notified via e-mail, typically within two
weeks.
Once I get access, who in my practice
may use my login to query the CSRS
database?
Because of strict confidentiality provi-sions
in the law, only the registered prac-titioner
may access the system. The law
prohibits other members of the practice
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
from using without their own username
and password.
How often is the database updated?
State law requires outpatient
dispensers of controlled substances to
report prescription data to the CSRS
once every 7 days so it may take up to
two weeks for a prescription to show
up in the system. Beginning on Janu-ary
1, 2014 pharmacies will be required
to report every 72 hours with 24 hour
reporting highly encouraged. This will
greatly reduce the lag time.
What if I have concerns about accura-cy
of the data, or a patient questions
its validity?
Contact John Womble at the Divi-sion
of Mental Health, Developmental
Disabilities and Substance Abuse Ser-vices,
Drug Control Unit at 919-733-
1765, Monday through Friday between
9 a.m. and 5 p.m.
This article was contributed by
the NC Department of Health and
Human Services – Division of Mental
Health, Developmental Disabilities
and Substance Abuse Services.
28 Bulletin {Of f icial Publ icat ion of the No r t h Ca r o l i n a Board of Nur s ing } . . . . . . . . . . . . . . . . . . Nursing
Do You Have a Sponsor – NCBON’s Update on Third Party
Payments
Trends in technology are leading NCBON, Pearson Vue and
NCSBN to a paperless trail, beginning October 2013. As part of
our commitment to reducing paper usage, the NCBON is launching
a new database system, and will continue to digitize reports, forms,
and other documents. In efforts to operate more effectively, the
NCBON updated policies in reference to third party payments.
What does this mean for perspective NCLEX candidates and their
sponsors? The NCBON will still welcome third party payments,
but the manner in which the NCBON receives and processes these
payments will differ from those in previous years.
Below are the new time lines and payment methods for sponsors:
October 5th, 2013 – NCBON will no longer accept paper
applications
• Candidates complete the Nurse Gateway Registration & the
online application
• Third party payees will submit payment to the NCBON
(company check, certified check, money order, credit/debit
card) with the applicants information attached
• Once payments clear the candidate’s account will be activated
January 1st, 2014 – NCSBN will no longer accept paper
registrations for testing through Pearson Vue
• Candidates will complete the registration through Pearson
Vue at www.pearsonvue.com
• Third party payees will be required to pay fees with a debit/
credit card or a prepaid VISA or MasterCard gift card, these
will be the only payment methods accepted
NCBON and NCSBN encourages program educators, private/
government agencies, and other sponsors to seek and secure payment
methods that will comply with the latest technology upgrades.
NCBON, Pearson Vue and NCSBN
to go paperless
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Nurse Network
Economical Classifieds (1.5” wide x 1” high)
Reach every nurse in North Carolina for as little as $290.
RESERVE YOUR SPACE NOW!
Contact Victor Horne: vhorne@pcipublishing.com 1-800-561-4686
31
Presorted Standard
U.S. Postage Paid
Little Rock, AR
P.O. Box 2129 Permit No. 1884
Raleigh, NC 27602-2129